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Improved myocardial function using cardiopulmonary support in resuscitation for hemorrhagic shock
J P Iguidbashian1, D M Follette, J P Contino
1Department of Surgery, University of California-Davis Medical Center, Sacramento.
Objectives:
To clarify the pathophysiologic characteristics of hemorrhagic shock and to assess methods of resuscitation.
Design:
An animal experiment using sheep subjected to hemorrhagic shock and fibrillation to compare various resuscitation techniques.
Setting:
An experimental laboratory setting meant to simulate hemorrhagic shock secondary to trauma.
Study Groups:
Group 1 animals (n = 6) were controls that were not subjected to shock and fibrillation. Group 2 animals (n = 6) were subjected to shock and fibrillation and were resuscitated with volume replacement. Group 3 animals (n = 6) were also subjected to shock and fibrillation but were resuscitated with epinephrine hydrochloride infusion. Group 4 animals (n = 6) were subjected to shock and fibrillation but were resuscitated with cardiopulmonary support.
Interventions:
The shock was to a mean arterial pressure of 25 mm Hg for 1 hour followed by 5 minutes of fibrillation. Group 2 animals were resuscitated for 1 hour. Group 3 animals were supported for 6 hours on epinephrine after the shock period. Group 4 animals were supported for 1 hour on cardiopulmonary support, then were observed for another 5 hours. All animals were sedated and intubated, and a median sternotomy was performed.
Main Outcomes Measured:
Survival, hemodynamic function, lactate production, myocardial blood flow, and water content.
Results:
Group 1 sheep showed no detrimental effects in any of the measured variables. Group 2 sheep could not be resuscitated. Group 3 sheep could be supported with epinephrine but had a 60% depression in left ventricular function and an ultimately high mortality rate (67%) when the infusion of epinephrine was discontinued. Group 4 sheep had a 100% survival rate and only a 20% deterioration in left ventricular function.
Conclusions:
Cardiopulmonary support improves survival and preserves left ventricular function compared with volume resuscitation with or without inotropic support in this model of hemorrhagic shock.