TY - JOUR
T1 - Testing of blood products in a polytrauma model
T2 - Results of a multi-institutional randomized preclinical trial
AU - Alam, Hasan B.
AU - Bice, Leticia M.
AU - Butt, Muhammad U.
AU - Cho, S. David
AU - Dubick, Michael A.
AU - Duggan, Michael
AU - Englehart, Michael S.
AU - Holcomb, John B.
AU - Morris, Melanie S.
AU - Prince, M. Dale
AU - Schreiber, Martin A.
AU - Shults, Christian
AU - Sondeen, Jill L.
AU - Tabbara, Malek
AU - Tieu, Brandon H.
AU - Underwood, Samantha A.
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2009/10
Y1 - 2009/10
N2 - Introduction: Trauma-induced coagulopathy, acidosis, and hypothermia form a "lethal triad" that is difficult to treat and is associated with extremely high mortality. This study was performed at three academic centers to evaluate whether resuscitation with blood components could reverse the coagulopathy in a complex polytrauma model. Methods: Yorkshire swine (40 ± 5 kg) were subjected to a three-phase protocol: (a) "Prehospital" phase ≤ femur fracture, hemorrhage (60% blood volume), and 30 minutes shock + infusion of saline (3 × shed blood) + induction of hypothermia (33°C); (b) "Early hospital" phase ≤ grade V liver injury; and (c) "Operative" phase≤ liver packing. After liver packing, the animals (n ≤ 60) were randomized to the following groups: (1) Sham-instrumentation and anesthesia without hemorrhage/injuries, (2) fresh whole blood (FWB), (3) 6% hetastarch (Hextend), (4) fresh frozen plasma/packed RBCs in 1:1 ratio (1:1 FFP/PRBC), and (5) FFP alone. Treatment volumes were equal to the volume of shed blood. Hemodynamic and physiologic parameters and coagulation profile (thrombelastography, prothrombin time, activated partial thromboplastin time, international normalized ratio, and platelets) were monitored during the experiment and for 4 hours posttreatment. Results: At the end of prehospital phase, animals had developed significant acidosis (lactate >5 mmol/L and base deficit >9 mmol/L) and coagulopathy. Posttreatment mortality rates were 85% and 0% for the Hextend and blood component treated groups, respectively (p < 0.05). Hemodynamic parameters and survival rates were similar in groups that were treated with blood products (FWB, FFP, and FFP:PRBC). Animals treated with FFP and Hextend had significant anemia compared with the groups that received red blood cells (FWB and FFP:PRBC). Treatment with FFP and FFP:PRBC corrected the coagulopathy as effectively as FWB, whereas Hextend treatment worsened coagulopathy. Conclusions: In this reproducible model, we have shown that trauma-associated coagulopathy is made worse by hetastarch, but it can be rapidly reversed with the administration of blood components. Impressively, infusion of FFP, even without any red blood cells, can correct the coagulopathy and result in excellent early survival.
AB - Introduction: Trauma-induced coagulopathy, acidosis, and hypothermia form a "lethal triad" that is difficult to treat and is associated with extremely high mortality. This study was performed at three academic centers to evaluate whether resuscitation with blood components could reverse the coagulopathy in a complex polytrauma model. Methods: Yorkshire swine (40 ± 5 kg) were subjected to a three-phase protocol: (a) "Prehospital" phase ≤ femur fracture, hemorrhage (60% blood volume), and 30 minutes shock + infusion of saline (3 × shed blood) + induction of hypothermia (33°C); (b) "Early hospital" phase ≤ grade V liver injury; and (c) "Operative" phase≤ liver packing. After liver packing, the animals (n ≤ 60) were randomized to the following groups: (1) Sham-instrumentation and anesthesia without hemorrhage/injuries, (2) fresh whole blood (FWB), (3) 6% hetastarch (Hextend), (4) fresh frozen plasma/packed RBCs in 1:1 ratio (1:1 FFP/PRBC), and (5) FFP alone. Treatment volumes were equal to the volume of shed blood. Hemodynamic and physiologic parameters and coagulation profile (thrombelastography, prothrombin time, activated partial thromboplastin time, international normalized ratio, and platelets) were monitored during the experiment and for 4 hours posttreatment. Results: At the end of prehospital phase, animals had developed significant acidosis (lactate >5 mmol/L and base deficit >9 mmol/L) and coagulopathy. Posttreatment mortality rates were 85% and 0% for the Hextend and blood component treated groups, respectively (p < 0.05). Hemodynamic parameters and survival rates were similar in groups that were treated with blood products (FWB, FFP, and FFP:PRBC). Animals treated with FFP and Hextend had significant anemia compared with the groups that received red blood cells (FWB and FFP:PRBC). Treatment with FFP and FFP:PRBC corrected the coagulopathy as effectively as FWB, whereas Hextend treatment worsened coagulopathy. Conclusions: In this reproducible model, we have shown that trauma-associated coagulopathy is made worse by hetastarch, but it can be rapidly reversed with the administration of blood components. Impressively, infusion of FFP, even without any red blood cells, can correct the coagulopathy and result in excellent early survival.
KW - Acidosis
KW - Coagulopathy
KW - Hemorrhage
KW - Hypothermia
KW - Liver injury
KW - Plasma
KW - Polytrauma
KW - Shock
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UR - http://www.scopus.com/inward/citedby.url?scp=72449209284&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e3181b5ae75
DO - 10.1097/TA.0b013e3181b5ae75
M3 - Article
C2 - 19820596
AN - SCOPUS:72449209284
SN - 0022-5282
VL - 67
SP - 856
EP - 864
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 4
ER -