Hypertonic Saline Dextran Ameliorates Organ Damage in Beagle Hemorrhagic Shock

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Critical Care Medicine

Background:

• Hemorrhagic shock poses significant challenges in resuscitation, necessitating effective fluid therapies.
• Organ damage is a critical complication following severe blood loss and resuscitation efforts.

Purpose of the Study:

• To evaluate the efficacy of hypertonic saline with 6% Dextran-70 (HSD) in mitigating organ damage.
• To assess the resuscitation efficiency of HSD alone and in combination with lactated ringers (LR) in a canine model of hemorrhagic shock.

Main Methods:

• Beagles experienced induced hemorrhagic shock, maintaining mean arterial pressure (MAP) at 50 ± 5 mmHg for 1 hour.
• Animals were randomized into three pre-hospital resuscitation groups: HSD (4 ml/kg), LR (40 ml/kg), or HSD+LR (4 ml/kg HSD + 40 ml/kg LR) for 1 hour.
• Subsequent in-hospital resuscitation with LR, followed by observation and autologous blood transfusion, with hemodynamic and oxygenation parameters monitored. Organ tissues were pathologically analyzed post-sacrifice.

Main Results:

• HSD resuscitation led to a faster initial MAP increase than LR, with similar overall hemodynamic performance throughout the experiment.
• The HSD group exhibited similar systemic oxygenation to LR but a lower venous-to-arterial CO2 gradient (Pv-aCO2) at the final measurement point (p < 0.05).
• Histological analysis revealed significantly lower kidney, lung, and liver damage scores in the HSD group compared to the LR group (p < 0.05). The HSD+LR group showed improved hemodynamics but increased lung water and decreased PaO2.

Conclusions:

• A bolus of HSD demonstrated comparable hemodynamic response to a ten-fold greater volume of LR, with superior organ protection.
• The combination of HSD and LR shows potential as an effective pre-hospital resuscitation strategy for hemorrhagic shock.