Jh. Siegel et al., USE OF RECOMBINANT HEMOGLOBIN SOLUTION IN REVERSING LETHAL HEMORRHAGIC HYPOVOLEMIC OXYGEN DEBT SHOCK, The journal of trauma, injury, infection, and critical care, 42(2), 1997, pp. 199-212
Objective: To compare recombinant hemoglobin solution (rHb1.1) with co
lloid/blood (CB) resuscitation in a hemorrhagic shock (HS) model based
on oxygen debt (O2D). Methods: Twenty-two anesthetized canines (weigh
t 23.3 +/- 0.2 kg) were bled to an O2D of 99.9 +/- 2.1 mL/kg over 60 m
inutes (estimated Lethal dose 31%), blood loss 65.9 +/- 2.3% of estima
ted blood volume, -199 g hemoglobin (Hgb). Prospectively randomized re
suscitation done in 20 minutes with 120% of shed blood volume, either
colloid 60%/blood 60% shed blood volume (CB), 118 g Hgb, or 120% shed
blood volume as 5% rHb1.1, 85 g Hgb, and fall in O2D was quantified ov
er 80 minutes, Six animals died during HS, one after CB resuscitation
(32% actual mortality), Blood lactate (L) and base deficit (BEA) were
related to O2D. Results: Both lactate (L) and BEA quantified O2D durin
g hemorrhage: L = 0.0671 (O2D) + 1.209; r(2) = 0.90, p < 0.0001; BEA =
0.1313 (O2D) + 1.764; r(2) = 0.90, p < 0.0001, but L was a better ind
icator than BEA of fall in O2D during resuscitation (L = 0.069 (O2D) 1.083; r(2) = 0.80), Both groups were followed for 7 days after HS an
d had normal renal and hepatic function by day 7, However, at equal re
suscitation volume, rHb1.1 resuscitation with 41% of Hgh loss produced
a more rapid initial fall in O2D than CB at 60% of Hgb loss (p < 0.00
2), rHb1.1 resuscitation also caused a more complete washout of metabo
lic acids than CB. Conclusions: Lactate and BEA accurately quantify O2
D in HS and resuscitation. rHb1.1 replacement is as good as CB with re
gard to survival, but leads to a more uniform reperfusion and produces
a more complete resolution of ischemic acidosis.