Abstract
Background: Hypotensive resuscitation is widely applied for trauma and war injury to reduce bleeding during damage-control resuscitation, but the treatment time window is limited in order to avoid hypoxia-associated organ injury. Whether a novel hemoglobin-based oxygen carrier (HBOC), YQ23 in this study, could protect organ function, and extend the Golden Hour for treatment is unclear. Method: Uncontrolled hemorrhagic shock rats and miniature pigs were infused with 0.5, 2, and 5% YQ23 before bleeding was controlled, while Lactate Ringer’s solution (LR) and fresh whole blood plus LR (WB + LR) were set as controls. During hypotensive resuscitation the mean blood pressure was maintained at 50–60 mmHg for 60 min. Hemodynamics, oxygen delivery and utilization, blood loss, fluid demand, organ function, animal survival as well as side effects were observed. Besides, in order to observe whether YQ23 could extend the Golden Hour, the hypotensive resuscitation duration was extended to 180 min and animal survival was observed. Results: Compared with LR, infusion of YQ23 in the 60 min pre-hospital hypotensive resuscitation significantly reduced blood loss and the fluid demand in both rats and pigs. Besides, YQ23 could effectively stabilize hemodynamics, and increase tissue oxygen consumption, increase the cardiac output, reduce liver and kidney injury, which helped to reduce the early death and improve animal survival. In addition, the hypotensive resuscitation duration could be extended to 180 min using YQ23. Side effects such as vasoconstriction and renal injury were not observed. The beneficial effects of 5% YQ23 are equivalent to similar volume of WB + LR. Conclusion: HBOC, such as YQ23, played vital roles in damage-control resuscitation for emergency care and benefited the uncontrolled hemorrhagic shock in the pre-hospital treatment by increasing oxygen delivery, reducing organ injury. Besides, HBOC could benefit the injured and trauma patients by extending the Golden Hour.
Highlights
More than half of the early trauma deaths are caused by hemorrhage and 30–40% of deaths occur within 30 minutes after injury (Brohi et al, 2019)
The results showed that YQ23 and WB + Lactate Ringer’s solution (LR) could significantly reduce blood loss in rats compared with LR, the blood loss proportion was 45.38 ± 4.08%, 46.58 ± 4.50% and 62.33 ± 3.93% in 5% YQ23, WB + LR and LR group, respectively, (Figures 2A,B)
In YQ23 groups, fluid demand was significantly decreased, and the volume of 5% YQ23 was only about 1/8 of the amount in LR group, which was equivalent to WB + LR (Figure 2C)
Summary
More than half of the early trauma deaths are caused by hemorrhage and 30–40% of deaths occur within 30 minutes after injury (Brohi et al, 2019). In order to reduce bleeding, stabilize the wounded and gain the time for follow-up treatment, damage control resuscitation have been proposed for early fluid resuscitation, including delayed resuscitation and hypotensive resuscitation (Cherkas, 2011; Bogert et al, 2016). Treatment time window for conventional fluid was small and 90 min is the bottom line for hypotensive resuscitation (Li et al, 2011), otherwise the mean arterial pressure (MAP) cannot be managed well, hemodynamic instability and severe organs injury occurs. It is urgent to find new resuscitation fluid that reduces bleeding and protects organ functions and extends the timeframe of pre-hospital treatment. Hypotensive resuscitation is widely applied for trauma and war injury to reduce bleeding during damage-control resuscitation, but the treatment time window is limited in order to avoid hypoxia-associated organ injury. Whether a novel hemoglobinbased oxygen carrier (HBOC), YQ23 in this study, could protect organ function, and extend the Golden Hour for treatment is unclear
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