Controlled resuscitation for uncontrolled hemorrhagic shock

David Burris, Peter Rhee, Christoph Kaufmann, Emmanouil Pikoulis, Brenda Austin, Alec Eror, Solenn DeBraux, Louis Guzzi, Ari Leppäniemi

Research output: Contribution to journalArticlepeer-review

142 Scopus citations

Abstract

Objective: To test the hypothesis that controlled resuscitation can lead to improved survival in otherwise fatal uncontrolled hemorrhage. Methods: Uncontrolled hemorrhage was induced in 86 rats with a 25-gauge needle puncture to the infrarenal aorta. Resuscitation 5 minutes after injury was continued for 2 hours with lactated Ringer's solution (LR), 7.3% hypertonic saline in 6% hetastarch (HH), or no fluid (NF). Fluids infused at 2 mL · kg-1 · min-1 were turned on or off to maintain a mean arterial pressure (MAP) of 40, 80, or 100 mm Hg in six groups: NF, LR 40, LR 80, LR 100, HH 40, and HH 80. Blood loss was measured before and after 1 hour of resuscitation. Results: Survival was improved with fluids. Preresuscitation blood loss was similar in all groups. NF rats did not survive 4 hours. After 72 hours, LR 80 rats (80%) and HH 40 rats (67%) showed improved survival over NF rats (0%) (p < 0.05). Rebleeding increased with MAP. Attempts to restore normal MAP (LR 100) led to increased blood loss and mortality. Conclusion: Controlled resuscitation leads to increased survival compared with no fluids or standard resuscitation. Fluid type affects results. Controlled fluid use should be considered when surgical care is not readily available.

Original languageEnglish (US)
Pages (from-to)216-223
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume46
Issue number2
DOIs
StatePublished - Feb 1999

Keywords

  • Hypertonic saline
  • Resuscitation
  • Uncontrolled hemorrhage
  • Vascular trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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