Abstract
We aimed to investigate the resuscitative efficacy of hemoglobin vesicles (HbVs) as a red blood cell (RBC) substitute for the initial treatment of severe postpartum hemorrhage (PPH). Twenty-five pregnant rabbits underwent cesarean section; uncontrolled hemorrhage was induced by transecting the right uterine artery to establish a severe PPH model. During the first 30 min, all rabbits were administered 6% hydroxyethyl starch (HES) of an equivalent volume to the hemorrhage every 5 min. Thereafter, they received any of the following three isovolemic fluids for resuscitation every 5 min: RBCs with platelet-poor plasma (RBC/PPP) (n = 8), 6% HES (n = 7), or HbVs with 25% human serum albumin (n = 10). After surgical hemostasis at 60 min, survival was monitored until 12 h. No rabbits receiving only HES infusion survived beyond 6 h, whereas all rabbits receiving RBC/PPP transfusion survived. The rabbits receiving HbV infusion showed significantly higher mean arterial pressure and hemoglobin levels than the HES-receiving rabbits, and 8 of 10 rabbits survived for 6 h. The HbV group showed significantly higher survival than the HES group but worse survival than the RBC/PPP group. In conclusion, HbV infusion for severe PPH effectively prevents lethal hemorrhagic shock in a pregnant rabbit model.
Highlights
We aimed to investigate the resuscitative efficacy of hemoglobin vesicles (HbVs) as a red blood cell (RBC) substitute for the initial treatment of severe postpartum hemorrhage (PPH)
Shock index was gradually increased in all groups; the shock index at 25–45 min was significantly higher in the hydroxyethyl starch (HES) group than in the other groups (P < 0.05), whereas no significant differences were observed among the three groups at 60 min (Fig. 2B)
Using the current PPH model, we demonstrated that HbVs helped to maintain hemodynamics during severe PPH
Summary
We aimed to investigate the resuscitative efficacy of hemoglobin vesicles (HbVs) as a red blood cell (RBC) substitute for the initial treatment of severe postpartum hemorrhage (PPH). Cell-free typed HBOCs exert some side effects of bared Hbs, including nitric oxide ( NO2−)-related vasoconstriction, hypertension, and higher infarction rates[8]. These results emphasize the significance of mimicking the cellular structure of RBCs. many studies have attempted Hb encapsulation using liposomes to improve biocompatibility, storage stability, and oxygen-carrying capacity. This study aimed to investigate the resuscitative efficacy of HbVs for PPH Toward this goal, we established a severe PPH model using pregnant rabbits based on top reflect clinical scenarios. We hypothesized in this study that HbVs could have a resuscitative effect on severe PPH as an alternative to blood transfusion
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