plasmalyte-a and Hemorrhage

Trauma-related hemorrhagic shock (HS) remains a leading cause of death among military and civilian trauma patients. We have previously shown that administration of complement and HMGB1 inhibitors attenuate morbidity and mortality 24 h after injury in a rat model of blast injury (BI) and HS. To further validate these results, this study aimed to develop a swine model and evaluate BI+HS-induced pathophysiology. Anesthetized Yucatan minipigs underwent combined BI and volume-controlled hemorrhage. After 30 min of shock, animals received an intravenous bolus of PlasmaLyte A and a continuous PlasmaLyte A infusion. The survival rate was 80% (4/5), and the non-survivor expired 72 min post-BI. Circulating organ-functional biomarkers, inflammatory biomarkers, histopathological evaluation, and CT scans indicated evidence of multiple-organ damage, systemic innate immunological activation, and local tissue inflammation in the injured animals. Interestingly, a rapid and dramatic increase in plasma levels of HMGB1 and C3a and markedly early myocarditis and encephalitis were associated with early death post-BI+HS. This study suggests that this model reflects the immunopathological alterations of polytrauma in humans during shock and prolonged damage control resuscitation. This experimental protocol could be helpful in the assessment of immunological damage control resuscitation approaches during the prolonged care of warfighters.

Topics: Animals; Blast Injuries; Disease Models, Animal; Hemorrhage; HMGB1 Protein; Humans; Rats; Shock, Hemorrhagic; Swine; Swine, Miniature

One half of deaths among trauma victims occur within 1 hour of injury and are due to rapid hemorrhage or CNS trauma. We developed a rapid hemorrhage model in unanesthetized swine to simulate human exsanguination. We compared the ability of four crystalloid solutions to prevent death after an otherwise fatal hemorrhage: normal saline (NS), Ringer's lactate (RL), Plasmalyte-A (PA), and Plasmalyte-R (PR). Five days before hemorrhage swine received an aortic sideport and a central venous treatment catheter. Aortic blood (54 ml/kg) was removed in 15 minutes from 116 swine. The percentages of shed blood replaced were 14% in 5 minutes with NS, 100% in 20 minutes with NS, and 300% in 30 minutes with NS, RL, PA, or PR. We found that all mortalities were determined within 2 hours after hemorrhage and that RL provided the best survival rate of 67% (NS 300% = 50%, PR = 40%, and PA = 30%.) After an analysis of arterial blood gas, lactate, acid-base, heart rate, and aortic pressure measurements, we conclude that RL is the superior crystalloid solution because of its decreased chloride load (compared to NS) and because of the absence of acetate or magnesium (compared to PA and PR).

Topics: Acid-Base Equilibrium; Animals; Carbon Dioxide; Crystalloid Solutions; Disease Models, Animal; Electrolytes; Female; Hemodynamics; Hemorrhage; Isotonic Solutions; Lactates; Oxygen; Plasma Substitutes; Resuscitation; Ringer's Lactate; Shock, Hemorrhagic; Sodium Chloride; Swine; Time Factors; Wounds and Injuries