EFFECT OF SUPPLEMENTAL PERFLUOROCARBON ADMINISTRATION ON HYPOTENSIVE RESUSCITATION OF SEVERE UNCONTROLLED HEMORRHAGE

Recent animal studies of acute hemorrhage in the presence of a vascula r injury have demonstrated improved survival and decreased hemorrhage volume with hypotensive resuscitation, but this has occurred at the ex pense of tissue perfusion. It was hypothesized that addition of an oxy gen-carrying perfusate would improve tissue oxygen delivery during hyp otensive resuscitation. Hypotensive resuscitation of severe uncontroll ed hemorrhage was compared with and without supplementation with Oxyge nt HT, an emulsion of perflubron (perfluorooctylbromide; PFOB; Allianc e Pharmaceutical Corporation, San Diego, CA), an oxygen-carrying perfu sate. Fifteen swine (15 to 22 kg) with 4-mm aortic tears were bled to a pulse pressure of 5 mm Hg and then resuscitated (estimated blood los s, 40 to 50 mL/kg), All animals were resuscitated with normal saline ( 6 mL/kg/min) infused as needed to maintain a mean arterial pressure of 40 mm Hg, One group (PFC) of animals also received an infusion of 6 m L/kg perfluorooctylbromide emulsion. Another group served as controls and received an equal volume of placebo (normal saline), Animals were observed for 120 minutes or until death, Data were compared using repe ated measures analysis of variance (ANOVA) the Student's t test, and F isher's exact, A P value <.05 was considered significant, Two-hour mor tality rates were 12.5% and 43% for PFC-treated animals and controls, respectively (P > .05; 95% confidence interval [95% CI] for this diffe rence in mortality is -13% to 74%). Oxygen content and delivery were s ignificantly greater in the treatment group, In conclusion, administra tion of an oxygen-carrying perfusate significantly improves oxygen del ivery in hypotensive crystalloid resuscitation of severe uncontrolled hemorrhage. Copyright (C) by W.B. Saunders Company