Abstract
BackgroundHemorrhage is the most common cause of preventable death in the pre-hospital phase in trauma, with a critical capability gap optimizing pre-hospital resuscitation in austere environments. One promising avenue is the concept of a multi-functional resuscitation fluid (MRF) that contains a blood product backbone with agents that promote clotting and enhance oxygen delivery. Oxygen therapeutics, such as hemoglobin based oxygen carriers(HBOCs) and perfluorocarbons(PFCs), may be a critical MRF component. Our purpose was to assess the efficacy of resuscitation with a PFC, dodecafluoropentane(DDFPe), compared to fresh whole blood(FWB).Methods and findingsForty-five swine(78±5kg) underwent splenectomy and controlled hemorrhage via femoral arterial catheter until shock physiology(lactate = 7.0) was achieved prior to randomization into the following groups: 1) Control-no intervention, 2)Hextend-500mL, 3)FFP-500mL, 4)FFP+DDFPe-500mL, 5)FWB-500mL. Animals were observed for an additional 180 minutes following randomization.ResultsBaseline physiologic values did not statistically differ. At T = 60min, FWB had significantly decreased lactate(p = 0.001) and DDFPe was not statistically different from control. There was no statistical significance in tissue oxygenation(StO2) between groups at T = 60min. Survival was highest in the FWB and Hextend groups(30% at 180min). Kaplan-Meier analysis showed decreased survival of DDFPe+FFP in comparison to FWB(p<0.05) and was not significantly different from control or FFP. Four animals who received DDFPe died within 10 minutes of administration. This study was limited by a group receiving DDFPe alone, however this would not be feasible in this lethal swine model as DDFPe given its small volume.ConclusionDDFPe administration with FFP does not improve survival or enhance tissue oxygenation. However, given similar survival rates of Hextend and FWB, there is evidence that an ideal MRF should contain an element of volume expansion to enhance oxygen delivery.
Highlights
Poor availability of blood products in austere environments is a challenge to effective pre-hospital trauma resuscitation
This study was limited by a group receiving Dodecafluoropentane emulsion (DDFPe) alone, this would not be feasible in this lethal swine model as DDFPe given its small volume
Given similar survival rates of Hextend and FWB, there is evidence that an ideal multifunctional resuscitation fluid (MRF) should contain an element of volume expansion to enhance oxygen delivery
Summary
Poor availability of blood products in austere environments is a challenge to effective pre-hospital trauma resuscitation. An optimal MRF will likely include a blood product based backbone, agents that promote clotting, and oxygen therapeutics (OT) to enhance oxygen carrying capacity Oxygen therapeutics, such as hemoglobin based oxygen carriers (HBOC) or perfluorocarbons (PFC), have shown promise as an alternative for resuscitation and oxygen delivery to tissues.[1,2] in recent trials, some have proven to carry significant risk to specific patient populations eliciting myocardial infarction, systemic vasoconstriction and renal dysfunction.[3] Despite the controversial interpretation of these studies, continued development of OTs has resulted in new formulations aimed at preventing interaction with vasculature, reducing extravasation, and decreasing oxidative stress.[2]. One promising avenue is the concept of a multi-functional resuscitation fluid (MRF) that contains a blood product backbone with agents that promote clotting and enhance oxygen delivery Oxygen therapeutics, such as hemoglobin based oxygen carriers(HBOCs) and perfluorocarbons(PFCs), may be a critical MRF component. Our purpose was to assess the efficacy of resuscitation with a PFC, dodecafluoropentane(DDFPe), compared to fresh whole blood(FWB)
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