Irrigation Fluid Composition Affects Hemostasis in Murine Bleeding Models

Abstract

Introduction: Intraoperative irrigation, usually with normal saline (NS), aids in bleeding identification and management. We investigated the effect of different irrigation fluids, with additives, on hemostasis using two bleeding models. Methods: C57BL/6J mice were subjected to a tail bleed model or uncontrolled abdominal hemorrhage via liver laceration followed by abdominal cavity irrigation. We compared NS, Lactated Ringers (LR), and PlasmaLyte. We examined NS and LR at different temperatures. NS or LR with calcium (Ca), or tranexamic acid (TXA) were studied. Results: Compared with room temperature (RT), increasing the temperature to 37°C and 42°C reduced tail vein bleeding times significantly in both NS and LR (all p < 0.001), with no significant differences between the two fluids. At RT, LR, but not PlasmaLyte, substantially reduced bleeding times in comparison to NS (p < 0.0001). Liver injury blood loss was lower in LR (p < 0.01). NS supplemented with 1 mEq/mL of Ca decreased bleeding time and blood loss volume (p < 0.01, and p < 0.0001, respectively), to similar levels as LR. NS with 150mg/mL of TXA markedly reduced bleeding time (p < 0.0001), and NS with 62.5 mg/mL TXA decreased blood loss (p < 0.01). Conclusion: While Ca- and TXA-supplemented NS reduced bleeding, LR remained superior to all irrigation fluid compositions. As LR contains Ca, and Ca-supplemented NS mirrored LR in response, Ca presence in the irrigation fluid seems key to improving solution’s hemostatic ability. Since warming the fluids normalized the choice of agents, the data suggest that Ca-containing fluids such as LR may be more suitable for hemostasis when used at RT.