PLASMA SUPPLEMENTATION IS BENEFICIAL FOR COAGULATION DURING SEVERE HEMORRHAGIC-SHOCK

BACKGROUND: Hemorrhagic shock (HS) often causes coagulopathy due, in p art, to decreased coagulation proteins. This study assessed the effica cy of fresh frozen plasma (FFP) in preventing this coagulopathy follow ing a canine model of HS designed to mimic bleeding with shock as seen in the emergency department followed by bleeding without shock as see n during operation for control of bleeding. METHODS: Twenty-two dogs h ad acute HS for 2 hours followed by resuscitation with red blood cells (RBC) plus lactated ringers (LR) or RBC and LR with FFP. After resusc itation, bleeding was continued for 1 hour while intravenous replaceme nt of RBC and LR with or without FFP was provided. Baseline, postshock , postresuscitation, post-1 hour exchange, postoperative day one and d ay two measurements included coagulation Factors I, II, V, VII, VIII, and X, and the prothrombin (PT), partial thromboplastin (PTT), and thr ombin times (TT). RESULTS: Baseline, postshock, and postresuscitation hemodynamic responses, coagulation factor levels, and coagulation time s were similar for both groups. By contrast, the 1-hour postex-change factors were depleted in the LR dogs compared to the FFP dogs. This de pletion correlated with prolonged PT, PTT, and TT in the LR dogs (mean 14, 35, and 8 seconds) compared to FFP dogs (9, 24, and 6 seconds). C ONCLUSIONS: Severe HS beyond one blood volume exceeds the interstitial stores of coagulation protein, thus necessitating FFP supplementation .