BackgroundHemorrhagic shock (HS) severely decreases oxygen (O2) delivery and induces cardiovascular collapse. In parallel to controlling the hemorrhage, doctors respond by infusing large volumes of red blood cells (RBCs) to restore blood volume, O2 carrying capacity, and hemodynamic stability. The quality of the transfused RBCs determines the recovery from HS, and extent of sequelae prompted by the HS. This study compares the ability to recover from HS with conventionally stored RBCs, anaerobically (O2 saturation <10%) stored RBCs, and anaerobic/hypercapnic (O2 saturation <10% & pCO2 (@37°C) ~70 mmHg) stored RBCs.MethodsPacked red blood cells (pRBCs) stored in AS‐3 after leukorfiltration were created from donor rats. pRBC were randomly stored under 1) conventional; 2) anaerobic; 3) anaerobic/hypercapnic conditions. Sprague‐Dawley rats (150–200g) were hemorrhaged (50% of blood volume), held in hypovolemia for 30 minutes, and resuscitated to recover blood pressure to 90% pre‐hemorrhage with pRBC stored for 3 weeks. Systemic hemodynamics, cardiac function, and blood gas parameters were monitored during shock and resuscitation. Vital organ inflammation, oxygenation, and function were evaluated post resuscitation. Data were analyzed using two‐way ANOVA, followed by the appropriate post hoc analyses.ResultsConventionally stored RBCs were susceptible to both biochemical and mechanical changes during storage compared to anaerobic and anaerobic/hypercapnic storage. 24‐hour post transfusion recovery of anaerobically and anaerobic/hypercapnic stored RBCs was significantly higher compared to conventionally stored RBCs (P<0.05). Shock impaired cardiac function and oxygen delivery and resuscitation with pRBCs restored cardiac output. Resuscitation with conventionally stored cells resulted in severe cardiac ischemia. Resuscitation with either anaerobic or anaerobic/hypercapnic required significantly lower volume (1.9 and 2 fewer units than conventional storage) of pRBC to preserve hemodynamics during resuscitation (P < 0.05). Animals resuscitated with conventionally stored RBCs showed impaired ability to deliver O2 to tissues, increased lung, liver, and spleen inflammatory markers, and decreased liver and kidney function, compared to animals resuscitated with either anaerobic or anaerobic/hypercapnic pRBC.ConclusionStudies indicate that anaerobic or anaerobic/hypercapnic storage of RBC can improve clinical outcomes from hemorrhagic shock in a rat model, as evidenced by hemodynamic stability, O2 delivery, and vital organ inflammation and function.Support or Funding InformationNIH Grants from the National Heart Lung and Blood Institute, T32‐HL105373, P01‐HL110900, R01‐HL126945. Financial support was received for Hemanext for the completion of the study. Hemanext did not participate in the implementation of the study.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.