Me. Brecher et al., The value of oxygen-carrying solutions in the operative setting, as determined by mathematical modeling, TRANSFUSION, 39(4), 1999, pp. 396-402
BACKGROUND: The use of oxygen carriers (red cell [RBC] substitutes) in acut
e trauma and in surgery, with or without the use of acute normovolemic hemo
dilution (ANH), is being investigated. Mathematical modeling was used to as
sess the impact of RBC substitutes with or without ANH, in the elective sur
gical setting.
STUDY DESIGN AND METHODS: Mathematical equations and computer models were d
eveloped on the basis of previously described mathematical principles, for
better understanding of the potential efficacy of RBC substitutes for blood
needs with or without ANH. Savings were calculated for a patient with a bl
ood volume of 5000 mt and an initial hematocrit (Hct) of 45 or 30 percent
RESULTS: Substantial increases in the tolerable blood losses (or reduced al
logeneic RBC needs) were most evident when the use of an RBC substitute to
achieve severe ANH to a Hct that the patient might not otherwise have been
able to tolerate was combined with the use of RBC substitutes as replacemen
t for the surgical blood subsequently lost. However, the benefit was greatl
y dependent on the patient's initial Hot. For example, for a patient with a
blood volume of 5000 mt and an initial Hct of 45 percent, a blood loss of
approximately 2500 mt resulted in a find Hct of 28 percent without the use
of an RBC substitute or ANH. In contrast, with the combined use of staged A
NH with an RBC substitute and the RBC substitute for lost surgical Mood, a
blood loss of up to 14.5 L could be tolerated. However, in an anemic patien
t (Mood volume 5000 mt, initial Hct 30%), a Hct of 28 percent cannot be sus
tained without the use of allogeneic RBCs for any of the described strategi
es, even when blood losses were as low as 1 L.
CONCLUSION: The use of RBC substitutes has the potential to result in a sub
stantial reduction in allogeneic RBC exposure. This benefit is essentially
limited to the nonanemic patient when the use of an RBC substitute is combi
ned with severe ANH and there is concomitant large perioperative Mood loss.
Anemic patients can be expected to have only limited benefit, because of a
n inability to sequester an adequate volume of autologous RBCs via ANH.