Resuscitation from hemorrhagic shock using polymerized hemoglobin compared to blood - 06/03/14
Abstract |
The development of an alternative to blood transfusion to treat severe hemorrhage remains a challenge, especially in far forward scenarios when blood is not available. Hemoglobin level (Hb)–based oxygen (O2) carriers (HBOCs) were developed to address this need. Hemopure (HBOC-201, bovine Hb glutamer-250; OPK Biotech, Cambridge, MA), one such HBOC, has been approved for clinical use in South Africa and Russia. At the time of its approval, however, few studies aimed to understand Hemopure's function, administration, and adverse effects compared to blood. We used intravital microscopy to study the microcirculation hemodynamics (arteriolar and venular diameters and blood flow and functional capillary density [FCD]) and oxygenation implications of Hemopure administration at different Hb concentrations—4, 8, and 12 gHb/dL—compared to fresh blood transfusion during resuscitation from hemorrhagic shock. Experiments were performed in unanesthetized hamsters instrumented with a skinfold window chamber, subjected to hemorrhage (50% of the blood volume), followed by 1-hour hypovolemic shock and fluid resuscitation (50% of the shed volume). Our results show that fluid resuscitation with Hemopure or blood restored systemic and microvascular parameters. Microcirculation O2 delivery was directly correlated with Hemopure concentration, although increased vasoconstriction was as well. Functional capillary density reflected the balance between enhanced O2 transport and reduced blood flow: 12 gHb/dL of Hemopure and blood decreased FCD compared to the lower concentrations of Hemopure (P < .05). The balance between O2 transport and tissue perfusion can provide superior resuscitation from hemorrhagic shock compared to blood transfusion by using a low Hb concentration of HBOCs relative to blood.
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☆ | Disclosures: The author declares no competing financial interests by the results presented in this manuscript. No financial support was received from OPK Biotech for the completion of the study. This investigation was supported by the following grants: NIH R01 HL52684, R01 HL064395, and R01 HL062318 and ARMY: W81XWH-11-2-0012. The author thanks Froilan P. Barra and Cynthia Walser for the surgical preparation of the animals. |
☆☆ | Author contributions: DO analyzed the data and wrote the manuscript, and MB analyzed the data. SY performed the experiments and gathered the data. PC designed the study, performed the experiments, analyzed the data, and wrote the manuscript. |
Vol 32 - N° 3
P. 248-255 - mars 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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