Abstract Number: PB0106
Meeting: ISTH 2021 Congress
Background: Hemorrhage is a major contributor to the massive burden caused by trauma, and treatment of trauma victims in austere settings can be challenging. We have previously shown that a low-volume resuscitation fluid cocktail containing vasopressin and fibrinogen improves vital organ perfusion while minimizing hemorrhage when delivered in two boluses 30 minutes apart in a swine model of polytrauma. However, each bolus caused a spike in mean arterial pressure, possibly leading to thrombus failure and contributing to hemorrhage. If the vasoactive cocktail were administered in a slower fashion, it could blunt these blood pressure spikes and further mitigate blood loss.
Aims: Determine whether administration of this multifunctional resuscitation fluid cocktail as a continuous infusion rather than as two boluses can improve outcomes in a swine model of polytrauma.
Methods: Eighteen immature, anesthetized, splenectomized Yorkshire swine were subjected to fluid percussion brain injury, femur fracture, catheter hemorrhage, and aortic tear. After a shock period, animals received 14 mL/kg of the previously described fluid resuscitation cocktail (hydroxyethyl starch solution with 0.8 U/kg vasopressin and 100 mg/kg fibrinogen). They were randomized to receive this either divided into two boluses delivered at 0 and 40 minutes after resuscitation began (n=9) or as a continuous infusion over 60 minutes (n=9). Animals were monitored for six hours or until time of death, after which intraperitoneal blood loss was measured. Hemorrhage volume was compared by t-test, and survival was compared by Kaplan-Meier log rank test.
Results: Baseline characteristics were similar between groups. Hemorrhage volume was lower with slow infusion compared to boluses (15.0 ± 11.2 vs. 26.1 ± 13.4 mL/kg, p=0.04). Survival was not significantly changed with infusion compared to boluses (78 vs 44% at six hours, p=0.16).
Conclusions: Delivery of a previously identified multifunctional resuscitation fluid cocktail as a continuous infusion rather than as boluses improved blood loss though not survival after injury.
To cite this abstract in AMA style:John AS, Wang X, Ringgold K, Stern S, White N. Delivery of a Resuscitation Fluid Cocktail Containing Fibrinogen and Vasopressin as an Infusion Rather than Boluses Improves Hemorrhage in Swine Polytrauma Model [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/delivery-of-a-resuscitation-fluid-cocktail-containing-fibrinogen-and-vasopressin-as-an-infusion-rather-than-boluses-improves-hemorrhage-in-swine-polytrauma-model/. Accessed September 24, 2021.
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