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Oxygen transport dynamics after resuscitation with a conjugated hemoglobin solution
Shaheen Wirk1, Steven N Vaslef
1Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|January 14, 2004
Summary
Pyridoxalated hemoglobin polyoxyethylene conjugate (PHP) effectively restores hemodynamic balance and oxygen delivery after hemorrhage, similar to shed blood. However, PHP may function as an oxygen sink, with low plasma contribution to oxygen consumption in anemia.
Area of Science:
- Biomedical Engineering
- Physiology
- Emergency Medicine
Background:
- Hemoglobin-based oxygen carriers (HBOCs) are investigated for treating hemorrhage.
- Pyridoxalated hemoglobin polyoxyethylene conjugate (PHP) is an HBOC designed to improve oxygen transport.
- The efficacy of PHP in oxygen off-loading at the tissue level requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of PHP compared to shed blood in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage.
- To assess the oxygen transport dynamics, including delivery and consumption, in different blood compartments (whole blood, red blood cells, plasma) following PHP resuscitation.
Main Methods:
- A before-after trial design was employed in an animal research laboratory.
- Ten female Yorkshire swine underwent a 25% controlled hemorrhage followed by resuscitation with crystalloid plus either shed blood or PHP.
- Hemodynamic parameters and oxygen transport dynamics were continuously monitored and analyzed using a compartmentalized approach.
Main Results:
- PHP resuscitation normalized heart rate closer to baseline levels and caused transiently elevated mean pulmonary arterial pressure, with no significant differences in overall hemodynamic balance compared to shed blood.
- The oxygen extraction ratio in red blood cells significantly increased in the PHP group, while plasma extraction ratio remained unchanged.
- Plasma, including PHP, contributed over 20% to oxygen delivery, but its relative contribution to oxygen consumption did not significantly change from baseline.
Conclusions:
- PHP demonstrates comparable efficacy to shed blood in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage.
- The limited contribution of plasma to oxygen consumption suggests that PHP may act as an oxygen sink, potentially impacting tissue oxygenation in anemic states.