Effects of resuscitation fluids on endothelial glycocalyx (EG) and coagulation in severe hemorrhagic shock (HS)

Abstract

To study the effects of resuscitation fluids on changes in coagulation and EG in HS, we studied venules of cremaster muscle of anesthetized rats subjected to 1h of HS (40% of blood volume, HEM only) followed by 1h resuscitation with Hextend (HEX), Ringer's lactate (RL), or fresh frozen plasma (FFP). EG thickness was estimated using dextrans of different molecular weights labeled with FITC or Texas Red. Blood gases, hematocrit, cell count, coagulation tests (ROTEM) were performed. EG thickness was 50% lower in HEM, RL and HEX groups. EXTEM: clotting time [CT] was longer for RL compared to other groups. Clot strength [G] in HEM was higher at post‐resuscitation compared to baseline. FIBTEM: maximal clot elasticity [MCE], maximum clot formation [MCF], thrombin generation and G were lower in RL and HEX groups than the others. Resuscitation with FFP was superior in reverting coagulopathy (no differences in CT, G and MCE compared to Sham) and restoring EG thickness. Resuscitation with RL and HEX reestablished mean arterial pressure and tissue perfusion but caused EG shedding and altered coagulation by reducing clot strength and elasticity, and diluting coagulation factors, in contrast to FFP. We showed that ROTEM can indentify changes in coagulation function in massive blood loss and HS‐associated coagulopathy in a rat model that also displayed microvascular changes.Supported by US Army Medical Research & Materiel Command.