Normal saline influences coagulation and endothelial function after traumatic brain injury and hemorrhagic shock in pigs

Simone E. Dekker, Martin Sillesen, Ted Bambakidis, Guang Jin, Baoling Liu, Christa Boer, Pär I. Johansson, Ihab Halaweish, Jake Maxwell, Hasan B. Alam*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of trauma-related deaths. These insults disrupt coagulation and endothelial systems. This study investigated whether previously reported differences in lesion size and brain swelling during normal saline (NS), colloids (Hextend [HEX]), and fresh frozen plasma (FFP) resuscitation are associated with differential effects on coagulation and endothelial systems. Methods We subjected 15 Yorkshire swine to TBI and HS (40% blood volume), and kept in HS for 2 hours before resuscitation with NS, HEX, or FFP. Markers of endothelial activation (E-selectin, Intercellular adhesion molecule [ICAM]-1), coagulation activation (prothrombin fragment 1 + 2), and natural anticoagulation (activated protein C [aPC]) were determined in serum and brain whole cell lysates. Results Serum levels of aPC were greater in the NS group (203 ± 30 pg/mL) compared with HEX (77 ± 28 pg/mL; P =.02) and FFP (110 ± 28 pg/mL; P =.09), as was PF 1 + 2 in the brain when compared with FFP (PF 1 + 2, 89 ± 46 vs 37 ± 14 ng/mL; P =.035). Brain E-selectin was greater in the NS group compared with FFP (3.36 ± 0.02 vs 3.31 ± 0.01 ng/mL; P =.029). Circulating ICAM-1 levels were increased in the NS group (151 ± 9 ng/mL) compared with the HEX (100 ± 9 ng/mL; P <.01) and FFP (108 ± 9 ng/mL; P =.01). Conclusion In this clinically realistic large animal model of TBI + HS, NS resuscitation was associated with an early activation of coagulation, natural anticoagulation, and endothelial systems, compared with HEX and FFP.

Original languageEnglish (US)
Pages (from-to)556-563
Number of pages8
JournalSurgery (United States)
Volume156
Issue number3
DOIs
StatePublished - Sep 2014

Funding

Funded by a grant from the US Army Medical Research Material Command GRANT T00521959 (to H.B.A.) and a grant from the Lundbeck Foundation R134-A12630 (to M.S and P.I.J).

ASJC Scopus subject areas

  • Surgery

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