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J Trauma Acute Care Surg. 2019 Apr 18. doi: 10.1097/TA.0000000000002315. [Epub ahead of print]

Selective Aortic Arch Perfusion with fresh whole blood or HBOC-201 reverses hemorrhage-induced traumatic cardiac arrest in a lethal model of non-compressible torso hemorrhage.

Author information

1
Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA.
2
Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill.
3
Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University.

Abstract

BACKGROUND:

Hemorrhage-induced traumatic cardiac arrest (HiTCA) has a dismal survival rate. Previous studies demonstrated selective aortic arch perfusion (SAAP) with fresh whole blood (FWB) improved the rate of return of spontaneous circulation (ROSC) after HiTCA, compared to REBOA and CPR. Hemoglobin-based oxygen carriers, such as HBOC-201, may alleviate the logistical constraints of using FWB in a prehospital setting. It is unknown whether SAAP with HBOC-201 is equivalent in efficacy to FWB, whether conversion from SAAP to Extracorporeal Life Support (ECLS) is feasible, and whether physiologic derangement post-SAAP therapy is reversible.

METHODS:

Twenty-six swine (79±4kg) were anesthetized and underwent HiTCA which was induced via liver injury and controlled hemorrhage. Following arrest, swine were randomly allocated to resuscitation using SAAP with FWB (n=12) or HBOC-201 (n=14). After SAAP was initiated, animals were monitored for a 20-minute pre-hospital period prior to a 40-minute damage control surgery and resuscitation phase, followed by 260 minutes of critical care. Primary outcomes included rate of ROSC, survival, conversion to ECLS, and correction of physiology.

RESULTS:

Baseline physiologic measurements were similar between groups. ROSC was achieved in 100% of the FWB animals and 86% of the HBOC-201 animals (p=0.483). Survival (t=320-min) was 92% (11/12) in the FWB group and 67% (8/12) in the HBOC-201 group (p=0.120). Conversion to ECLS was successful in 100% of both groups. Lactate peaked at 80 minutes in both groups, and significantly improved by end of experiment in the HBOC-201 group (p=0.001) but not in the FWB group (p=0.104). There was no significant difference in peak or end lactate between groups.

CONCLUSIONS:

SAAP is effective in eliciting ROSC after HiTCA in a swine model, using either FWB or HBOC-201. Transition from SAAP to ECLS after definitive hemorrhage control is feasible, resulting in high overall survival and improvement in lactic acidosis over the study period.

LEVEL OF EVIDENCE:

Basic science, therefore this study does not require a defined level ofevidence STUDY TYPE: Therapeutic.

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