Oxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions

J. Sprung, C. F. Mackenzie, G. M. Barnas, J. E. Williams, M. Parr, R. H. Christenson, B. H. Hoff, R. Sakamoto, A. Kramer, Mark Allan Lottes

Research output: Contribution to journalArticle

Abstract

Objective: To test the short-term efficacy of three hemoglobin solutions in restoring cardiac output, intravascular pressures, oxygen transport (ḊO2), and oxygen consumption (V̇O2) after resuscitation from severe hemorrhagic shock. Design: Prospective study. Setting: Research laboratory. Subjects: Beagle dogs. Interventions: After anesthesia and instrumentation, hemorrhagic shock was induced for 2 hrs by blood withdrawal to maintain systolic blood pressure at 50 mm Hg. Resuscitation then occurred with one of four different resuscitation fluids. One group of dogs was not resuscitated. Survival rate was monitored for 8 days. Measurements and Main Results: In 33 beagle dogs, cardiovascular variables (ḊO2 and V̇O2) were compared after resuscitation with 8% stroma-free hemoglobin, 4% or 8% pyridoxalated- hemoglobin-polyoxyethylene conjugate (PHP44 and PHP88, respectively), or autologous whole blood. The dogs were anesthetized, paralyzed, mechanically ventilated (FIO2 of 0.21), and instrumented with arterial and pulmonary artery catheters. An average of 63% of estimated blood volume was removed to maintain systolic blood pressure at 50 mm Hg for 2 hrs. The dogs then were either not resuscitated (n = 4) or resuscitated with 8% stroma-free hemoglobin (n = 7), PHP44 (n = 6), PHP88 (n = 8), or whole blood (n = 8), with a volume equivalent to the withdrawn blood. Cardiovascular variables, ḊO2, V̇O2, oxygen extraction ratios, and blood concentrations of lactic acid and catecholamines were determined before, and for ≤6 hrs after, resuscitation from hemorrhagic shock. Blood smears were microscopically examined. In addition, the survival rate was monitored for 8 days after resuscitation. By 2 hrs of hemorrhagic shock, there was a large decrease in ḊO2 (p <.05) and an increase in oxygen extraction ratio from 0.27 to 0.70 (p <.05). There was a 3.5-fold increase in catecholamine concentrations and a 25-fold increase in catecholamine concentrations as compared with preshock values. All dogs not resuscitated died within 1.75 hrs after 2 hrs of shock. After resuscitation with whole blood, all cardiovascular and oxygen transport variables returned to approximately prehemorrhage values and remained so throughout the measurement period. After resuscitation with any hemoglobin solution, ḊO2 returned transiently to control values. However, recovery of ḊO2 was short-lived in all hemoglobin solution groups, and, by 4 hrs postresuscitation in all groups, ḊO2 was less than the ḊO2 of the dogs receiving whole blood (p <.05). These changes were associated with decreases in total hemoglobin concentrations compared with the values immediately before resuscitation (p <.05). In addition, with resuscitation using the PHP solutions, blood smears demonstrated aggregation of red blood cells and platelets. On day 8 after hemorrhagic shock, the survival rate was 100% for whole blood and PHP44, 86% for 8% stroma-free hemoglobin, and 33% for PHP88. Conclusions: Resuscitation from severe hemorrhagic shock with 8% stroma-free hemoglobin, PHP44, or PHP88 is equally effective in restoring cardiac index and vascular pressures as using whole blood. However, resuscitation with the three hemoglobin solutions only.transiently restored ḊO2 after hemorrhagic shock. The subsequent reduction of ḊO2 compared with the ḊO2 value using whole blood was due mostly to hemodilution. With the two PHP solutions, formation of red blood cell aggregates probably resulted in sequestration of red cell mass and additional loss of oxygen carrying capacity.

Original languageEnglish (US)
Pages (from-to)1540-1553
Number of pages14
JournalCritical Care Medicine
Volume23
Issue number9
DOIs
StatePublished - 1995
Externally publishedYes

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Hemorrhagic Shock
Resuscitation
Hemoglobins
Oxygen
Dogs
Blood Pressure
Catecholamines
Erythrocytes
Erythrocyte Volume
Pressure
Hemodilution
Conservation of Natural Resources
Blood Volume
Oxygen Consumption
Cardiac Output
Pulmonary Artery
Blood Vessels
Shock
Lactic Acid
Blood Platelets

Keywords

  • blood
  • cardiac output
  • hemoglobin
  • hemoglobin
  • hemorrhage
  • hemorrhagic shock
  • oxygen consumption
  • oxygen transport
  • resuscitation
  • vascular resistance

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Oxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions. / Sprung, J.; Mackenzie, C. F.; Barnas, G. M.; Williams, J. E.; Parr, M.; Christenson, R. H.; Hoff, B. H.; Sakamoto, R.; Kramer, A.; Lottes, Mark Allan.

In: Critical Care Medicine, Vol. 23, No. 9, 1995, p. 1540-1553.

Research output: Contribution to journalArticle

Sprung, J, Mackenzie, CF, Barnas, GM, Williams, JE, Parr, M, Christenson, RH, Hoff, BH, Sakamoto, R, Kramer, A & Lottes, MA 1995, 'Oxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions', Critical Care Medicine, vol. 23, no. 9, pp. 1540-1553. https://doi.org/10.1097/00003246-199509000-00015
Sprung, J. ; Mackenzie, C. F. ; Barnas, G. M. ; Williams, J. E. ; Parr, M. ; Christenson, R. H. ; Hoff, B. H. ; Sakamoto, R. ; Kramer, A. ; Lottes, Mark Allan. / Oxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions. In: Critical Care Medicine. 1995 ; Vol. 23, No. 9. pp. 1540-1553.
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title = "Oxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions",
abstract = "Objective: To test the short-term efficacy of three hemoglobin solutions in restoring cardiac output, intravascular pressures, oxygen transport (ḊO2), and oxygen consumption (V̇O2) after resuscitation from severe hemorrhagic shock. Design: Prospective study. Setting: Research laboratory. Subjects: Beagle dogs. Interventions: After anesthesia and instrumentation, hemorrhagic shock was induced for 2 hrs by blood withdrawal to maintain systolic blood pressure at 50 mm Hg. Resuscitation then occurred with one of four different resuscitation fluids. One group of dogs was not resuscitated. Survival rate was monitored for 8 days. Measurements and Main Results: In 33 beagle dogs, cardiovascular variables (ḊO2 and V̇O2) were compared after resuscitation with 8{\%} stroma-free hemoglobin, 4{\%} or 8{\%} pyridoxalated- hemoglobin-polyoxyethylene conjugate (PHP44 and PHP88, respectively), or autologous whole blood. The dogs were anesthetized, paralyzed, mechanically ventilated (FIO2 of 0.21), and instrumented with arterial and pulmonary artery catheters. An average of 63{\%} of estimated blood volume was removed to maintain systolic blood pressure at 50 mm Hg for 2 hrs. The dogs then were either not resuscitated (n = 4) or resuscitated with 8{\%} stroma-free hemoglobin (n = 7), PHP44 (n = 6), PHP88 (n = 8), or whole blood (n = 8), with a volume equivalent to the withdrawn blood. Cardiovascular variables, ḊO2, V̇O2, oxygen extraction ratios, and blood concentrations of lactic acid and catecholamines were determined before, and for ≤6 hrs after, resuscitation from hemorrhagic shock. Blood smears were microscopically examined. In addition, the survival rate was monitored for 8 days after resuscitation. By 2 hrs of hemorrhagic shock, there was a large decrease in ḊO2 (p <.05) and an increase in oxygen extraction ratio from 0.27 to 0.70 (p <.05). There was a 3.5-fold increase in catecholamine concentrations and a 25-fold increase in catecholamine concentrations as compared with preshock values. All dogs not resuscitated died within 1.75 hrs after 2 hrs of shock. After resuscitation with whole blood, all cardiovascular and oxygen transport variables returned to approximately prehemorrhage values and remained so throughout the measurement period. After resuscitation with any hemoglobin solution, ḊO2 returned transiently to control values. However, recovery of ḊO2 was short-lived in all hemoglobin solution groups, and, by 4 hrs postresuscitation in all groups, ḊO2 was less than the ḊO2 of the dogs receiving whole blood (p <.05). These changes were associated with decreases in total hemoglobin concentrations compared with the values immediately before resuscitation (p <.05). In addition, with resuscitation using the PHP solutions, blood smears demonstrated aggregation of red blood cells and platelets. On day 8 after hemorrhagic shock, the survival rate was 100{\%} for whole blood and PHP44, 86{\%} for 8{\%} stroma-free hemoglobin, and 33{\%} for PHP88. Conclusions: Resuscitation from severe hemorrhagic shock with 8{\%} stroma-free hemoglobin, PHP44, or PHP88 is equally effective in restoring cardiac index and vascular pressures as using whole blood. However, resuscitation with the three hemoglobin solutions only.transiently restored ḊO2 after hemorrhagic shock. The subsequent reduction of ḊO2 compared with the ḊO2 value using whole blood was due mostly to hemodilution. With the two PHP solutions, formation of red blood cell aggregates probably resulted in sequestration of red cell mass and additional loss of oxygen carrying capacity.",
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TY - JOUR

T1 - Oxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions

AU - Sprung, J.

AU - Mackenzie, C. F.

AU - Barnas, G. M.

AU - Williams, J. E.

AU - Parr, M.

AU - Christenson, R. H.

AU - Hoff, B. H.

AU - Sakamoto, R.

AU - Kramer, A.

AU - Lottes, Mark Allan

PY - 1995

Y1 - 1995

N2 - Objective: To test the short-term efficacy of three hemoglobin solutions in restoring cardiac output, intravascular pressures, oxygen transport (ḊO2), and oxygen consumption (V̇O2) after resuscitation from severe hemorrhagic shock. Design: Prospective study. Setting: Research laboratory. Subjects: Beagle dogs. Interventions: After anesthesia and instrumentation, hemorrhagic shock was induced for 2 hrs by blood withdrawal to maintain systolic blood pressure at 50 mm Hg. Resuscitation then occurred with one of four different resuscitation fluids. One group of dogs was not resuscitated. Survival rate was monitored for 8 days. Measurements and Main Results: In 33 beagle dogs, cardiovascular variables (ḊO2 and V̇O2) were compared after resuscitation with 8% stroma-free hemoglobin, 4% or 8% pyridoxalated- hemoglobin-polyoxyethylene conjugate (PHP44 and PHP88, respectively), or autologous whole blood. The dogs were anesthetized, paralyzed, mechanically ventilated (FIO2 of 0.21), and instrumented with arterial and pulmonary artery catheters. An average of 63% of estimated blood volume was removed to maintain systolic blood pressure at 50 mm Hg for 2 hrs. The dogs then were either not resuscitated (n = 4) or resuscitated with 8% stroma-free hemoglobin (n = 7), PHP44 (n = 6), PHP88 (n = 8), or whole blood (n = 8), with a volume equivalent to the withdrawn blood. Cardiovascular variables, ḊO2, V̇O2, oxygen extraction ratios, and blood concentrations of lactic acid and catecholamines were determined before, and for ≤6 hrs after, resuscitation from hemorrhagic shock. Blood smears were microscopically examined. In addition, the survival rate was monitored for 8 days after resuscitation. By 2 hrs of hemorrhagic shock, there was a large decrease in ḊO2 (p <.05) and an increase in oxygen extraction ratio from 0.27 to 0.70 (p <.05). There was a 3.5-fold increase in catecholamine concentrations and a 25-fold increase in catecholamine concentrations as compared with preshock values. All dogs not resuscitated died within 1.75 hrs after 2 hrs of shock. After resuscitation with whole blood, all cardiovascular and oxygen transport variables returned to approximately prehemorrhage values and remained so throughout the measurement period. After resuscitation with any hemoglobin solution, ḊO2 returned transiently to control values. However, recovery of ḊO2 was short-lived in all hemoglobin solution groups, and, by 4 hrs postresuscitation in all groups, ḊO2 was less than the ḊO2 of the dogs receiving whole blood (p <.05). These changes were associated with decreases in total hemoglobin concentrations compared with the values immediately before resuscitation (p <.05). In addition, with resuscitation using the PHP solutions, blood smears demonstrated aggregation of red blood cells and platelets. On day 8 after hemorrhagic shock, the survival rate was 100% for whole blood and PHP44, 86% for 8% stroma-free hemoglobin, and 33% for PHP88. Conclusions: Resuscitation from severe hemorrhagic shock with 8% stroma-free hemoglobin, PHP44, or PHP88 is equally effective in restoring cardiac index and vascular pressures as using whole blood. However, resuscitation with the three hemoglobin solutions only.transiently restored ḊO2 after hemorrhagic shock. The subsequent reduction of ḊO2 compared with the ḊO2 value using whole blood was due mostly to hemodilution. With the two PHP solutions, formation of red blood cell aggregates probably resulted in sequestration of red cell mass and additional loss of oxygen carrying capacity.

AB - Objective: To test the short-term efficacy of three hemoglobin solutions in restoring cardiac output, intravascular pressures, oxygen transport (ḊO2), and oxygen consumption (V̇O2) after resuscitation from severe hemorrhagic shock. Design: Prospective study. Setting: Research laboratory. Subjects: Beagle dogs. Interventions: After anesthesia and instrumentation, hemorrhagic shock was induced for 2 hrs by blood withdrawal to maintain systolic blood pressure at 50 mm Hg. Resuscitation then occurred with one of four different resuscitation fluids. One group of dogs was not resuscitated. Survival rate was monitored for 8 days. Measurements and Main Results: In 33 beagle dogs, cardiovascular variables (ḊO2 and V̇O2) were compared after resuscitation with 8% stroma-free hemoglobin, 4% or 8% pyridoxalated- hemoglobin-polyoxyethylene conjugate (PHP44 and PHP88, respectively), or autologous whole blood. The dogs were anesthetized, paralyzed, mechanically ventilated (FIO2 of 0.21), and instrumented with arterial and pulmonary artery catheters. An average of 63% of estimated blood volume was removed to maintain systolic blood pressure at 50 mm Hg for 2 hrs. The dogs then were either not resuscitated (n = 4) or resuscitated with 8% stroma-free hemoglobin (n = 7), PHP44 (n = 6), PHP88 (n = 8), or whole blood (n = 8), with a volume equivalent to the withdrawn blood. Cardiovascular variables, ḊO2, V̇O2, oxygen extraction ratios, and blood concentrations of lactic acid and catecholamines were determined before, and for ≤6 hrs after, resuscitation from hemorrhagic shock. Blood smears were microscopically examined. In addition, the survival rate was monitored for 8 days after resuscitation. By 2 hrs of hemorrhagic shock, there was a large decrease in ḊO2 (p <.05) and an increase in oxygen extraction ratio from 0.27 to 0.70 (p <.05). There was a 3.5-fold increase in catecholamine concentrations and a 25-fold increase in catecholamine concentrations as compared with preshock values. All dogs not resuscitated died within 1.75 hrs after 2 hrs of shock. After resuscitation with whole blood, all cardiovascular and oxygen transport variables returned to approximately prehemorrhage values and remained so throughout the measurement period. After resuscitation with any hemoglobin solution, ḊO2 returned transiently to control values. However, recovery of ḊO2 was short-lived in all hemoglobin solution groups, and, by 4 hrs postresuscitation in all groups, ḊO2 was less than the ḊO2 of the dogs receiving whole blood (p <.05). These changes were associated with decreases in total hemoglobin concentrations compared with the values immediately before resuscitation (p <.05). In addition, with resuscitation using the PHP solutions, blood smears demonstrated aggregation of red blood cells and platelets. On day 8 after hemorrhagic shock, the survival rate was 100% for whole blood and PHP44, 86% for 8% stroma-free hemoglobin, and 33% for PHP88. Conclusions: Resuscitation from severe hemorrhagic shock with 8% stroma-free hemoglobin, PHP44, or PHP88 is equally effective in restoring cardiac index and vascular pressures as using whole blood. However, resuscitation with the three hemoglobin solutions only.transiently restored ḊO2 after hemorrhagic shock. The subsequent reduction of ḊO2 compared with the ḊO2 value using whole blood was due mostly to hemodilution. With the two PHP solutions, formation of red blood cell aggregates probably resulted in sequestration of red cell mass and additional loss of oxygen carrying capacity.

KW - blood

KW - cardiac output

KW - hemoglobin

KW - hemoglobin

KW - hemorrhage

KW - hemorrhagic shock

KW - oxygen consumption

KW - oxygen transport

KW - resuscitation

KW - vascular resistance

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