FLUID AND ELECTROLYTE DEFICIT WITH PROLONGED PNEUMATIC ANTISHOCK GARMENT APPLICATION

Objective: When trauma victims are within 1 hour of definitive surgica l care, prehospital pneumatic antishock garment (PASG) application has not improved outcome. A resuscitative role for PASG has been suggeste d when transport time is longer (e.g., 4 hours). We assessed the fluid and electrolyte cost of treating posthemorrhagic hypotension with the PASG in 16 anesthetized Yorkshire piglets (30 to 32 kg). Design: Hypo tension [30 mm Hg drop in carotid arterial blood pressure (CBP)] was p roduced by arterial line bleeding. Hemodynamics, serum electrolytes, l actate, and tissue edema (limb circumference) were monitored. Material s and Methods: In eight animals (group 1), PASG was inflated to mainta in prebleed CBP for 4 hours. In group 2, the hypotension was untreated for 4 hours. After 4 hours, shed blood (over a period of 15 minutes) and normal Saline (1.5 mL/kg/minute) were infused until CBP returned t o normal baseline values. Measurements and Main Results: Shed blood al one did not restore baseline CBP. Serum K+ increased from a baseline o f 3.9 to 9.1 mmol/L in group 1, with no significant change in group 2. Serum lactate rose from 1.8 to 24.1 and from 1.7 to 6.8 mmol/L in gro ups 1 and 2, respectively. After 4 1/2 hours, an increase in thigh cir cumference (6.4 +/- 1.4 vs. 1.9 +/- 1.0 mm) and intravenous fluid requ ired after returning shed blood (626 +/- 36 vs. 324 +/- 22 mL) was gre ater in group I (means +/- SD, p < 0.05). Other serum electrolyte valu es were similar for the two groups. Conclusions: We conclude that flui d deficit, lactic acidosis, tissue edema, and hyperkalemia are all gre ater with prolonged PASG application when compared with the untreated hypotensive state. These findings must be considered when suggesting m ore prolonged PASG application.