Carlos J Munoz, Daniela Lucas, Ivan S Pires, Thekla Cordes, Cynthia Muller, Krianthan Govender, Amanda Breton, Christian M Metallo, Andre F Palmer, Pedro Cabrales
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引用次数: 0
Abstract
Introduction: Low titer O positive Whole Blood (LTOWB) has been introduced in prehospital care to resuscitate patients; however, the logistical obstacles, cost of carrying LTOWB, and the availability of it in trauma situations are a point of concern. Therefore, fluids, like Lactated Ringer's (LR) and hydroxyethyl starch (HES) have been considered alternatives to LTOWB transfusion. Unfortunately, they dilute plasma proteins in the circulation and have unfavorable side effects. This study presents an alternative, a Protein Cocktail (PC). The PC combines human serum albumin, transferrin, haptoglobin, and hemopexin. This study compares the ability to resuscitate from hemorrhagic shock (HS) with Whole Blood (WB), LR, 6% HES, and PC.
Methods: Unanesthetized Golden Syrian hamsters instrumented with the dorsal window chambers were subjected to hemorrhage (50% blood volume), followed by 30 min hypovolemic shock, and resuscitated with 50% shed volume. The outcome was evaluated through systemic parameters, blood gases, microcirculatory hemodynamics, oxygen tension and saturation, metabolomics, and markers of organ injury/function. Additionally, to investigate the impact of the experimental solutions on the coagulation cascade, Sprague Dawley rats were subjected to an isovolemic exchange-infusion of 20% of the animal's blood volume.
Results: The PC showed favorable outcomes, restoring microvasculature hemodynamics comparable to resuscitation with Whole Blood and superior to Lactated Ringer's and HES. PC reduced acute inflammation, positively impacted organ function markers, and restore metabolomic homeostasis without coagulopathies observed with HES.
Conclusion: In conclusion, the Protein Cocktail (PC) shows some promise as a resuscitation from hemorrhagic shock when Whole Blood is not available, and superior to classic crystalloids and colloids (LR and HES). Further studies with the PC are needed to ensure its efficacy and safety in other experimental models.
期刊介绍：
SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.
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