Microvascular and Systemic Impact of Resuscitation with PEGylated Carboxyhemoglobin-Based Oxygen Carrier or Hetastarch in a Rat Model of Transient Hemorrhagic Shock.
Shock
; 53(4): 493-502, 2020 04.
Article
em En
| MEDLINE
| ID: mdl-31045989
ABSTRACT
BACKGROUND:
Hemorrhage is the leading cause of preventable, traumatic death. Currently, prehospital resuscitation fluids provide preload but not oxygen-carrying capacity-a critical blood function that mitigates microvascular ischemia and tissue hypoxia during hemorrhagic shock. Solutions containing polymerized hemoglobin have been associated with vasoactive and hypertensive events. A novel hemoglobin-based oxygen carrier, modified with PEGylation and CO moieties (PEG-COHb), may overcome these limitations.OBJECTIVES:
To evaluate the systemic and microcirculatory effects of PEG-COHb as compared with the 6% hetastarch in a rat model of hemorrhagic shock.METHODS:
Male Sprague Dawley rats (Nâ=â20) were subjected to severe, controlled, hemorrhagic shock. Animals were randomized to 20% estimated blood-volume resuscitation with either 6% hetastarch or PEG-COHb. Continuous, invasive, cardiovascular measurements, and arterial blood gases were measured. Microcirculatory measurements of interstitial oxygenation (PISFO2) and vasoactivity helped model oxygen delivery in the spinotrapezius muscle using intravital and phosphorescence quenching microscopy.RESULTS:
Hemorrhage reduced mean arterial pressure (MAP), arteriolar diameter, and PISFO2, and increased lactate 10-fold in both groups. Resuscitation with both PEG-COHb and hetastarch improved cardiovascular parameters. However, PEG-COHb treatment resulted in higher MAP (Pâ<â0.001), improved PISFO2 (14 [PEG-COHb] vs. 5 [hetastarch] mmHg; Pâ<â0.0001), lower lactate post-resuscitation (Pâ<â0.01), and extended survival from 90 to 142 min (Pâ<â0.001) as compared with the hetastarch group.CONCLUSIONS:
PEG-COHb improved MAP PISFO2, lactate, and survival time as compared with 6% hetastarch resuscitation. Importantly, hypertension and vasoactivity were not detected in response to PEG-COHb resuscitation supporting further investigation of this resuscitation strategy.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Polietilenoglicóis
/
Ressuscitação
/
Choque Hemorrágico
/
Carboxihemoglobina
/
Hemoglobinas
/
Derivados de Hidroxietil Amido
/
Substitutos do Plasma
Limite:
Animals
Idioma:
En
Revista:
Shock
Ano de publicação:
2020
Tipo de documento:
Article