Shock-induced systemic hyperfibrinolysis is attenuated by plasma-first resuscitation

Area of Science:

• Trauma and Emergency Medicine
• Hemorrhagic Shock Research
• Resuscitation Fluid Studies

Background:

• Hemorrhagic shock presents challenges in prehospital settings with limited resuscitation fluids.
• Saline dilution exacerbates tissue plasminogen activator (tPA)-mediated fibrinolysis in vitro, unlike plasma.
• Hypothesis: Plasma attenuates shock-induced hyperfibrinolysis, while saline worsens it.

Purpose of the Study:

• To evaluate the efficacy of plasma versus normal saline (NS) for resuscitation in a severe hemorrhagic shock animal model.
• To assess the impact of different resuscitation fluids on hyperfibrinolysis and survival in a prehospital context.

Main Methods:

• Developed a rat model of hemorrhagic shock (MAP 25 mm Hg for 30 min).
• Resuscitated with normal saline (NS) or platelet-free plasma (PFP) (10% total blood volume bolus).
• Analyzed hemodynamic response, survival, thrombelastography (LY30), and tPA levels.

Main Results:

• Survival rates were 50% with NS versus 100% with PFP.
• Resuscitation with NS significantly increased LY30 (hyperfibrinolysis marker) compared to PFP.
• While initial tPA levels were similar, post-resuscitation changes in LY30 indicated PFP attenuated hyperfibrinolysis.

Conclusions:

• Plasma is a superior resuscitation fluid to NS in severe hemorrhagic shock.
• Plasma effectively attenuates systemic hyperfibrinolysis driven by hypoperfusion and tPA.
• Plasma resuscitation improves survival and systemic perfusion in a prehospital shock model.