Comparison of Adsol and CPDA-1 blood preservatives during simulated massive resuscitation after hemorrhage in swine

BACKGROUND: In recent years, there has been a change from the use of blood stored in CPDA-1 to the use of red cells (RBCs) stored in electrolyte mixtu res, such as Adsol (AS-l RBCs). However, because Adsol contains mannitol, a s well as increased amounts of glucose relative to CPD and CPDA-1, concerns have been expressed as to possible harmful effects (recipient hyperglycemi a, inappropriate osmotic diuresis) that it might induce under conditions of massive RBC transfusion. STUDY DESIGN AND METHODS: A hemorrhagic shock animal model was used to eval uate the effects of large-volume infusion of CPDA-1 or Adsol on glucose hom eostasis and on urinary output under conditions that were devoid of extensi ve surgical manipulation. Hemorrhage was induced in 10 female Pitman-Moore mini-pigs to maintain mean arterial blood pressure at 55 mmHg for 90 minute s. After the return of autologous RBCs plus 1 L of 0.9-percent sodium chlor ide, the animals were given solution equivalent to the solute load in eithe r 20 units of CPDA-1 whole blood (63 mt x 20 = 1260 mt) or 20 units of AS-I RBCs (100 mt x 20 = 2000 mt) over a period of 90 minutes. Animals were mon itored to determine physiologic and blood chemical responses to infusion of the solutions and to determine if there was hyperglycemia or inappropriate diuresis in the Adsol-treated group. RESULTS: Animals that received CPDA-1 developed significant hypocalcemia, a rterial hypotension, and elevated blood glucose concentrations; two of five animals died of circulatory collapse. In contrast, glucose metabolism in t he Adsol recipients was well-regulated, serum ionized calcium concentration was not significantly altered, and all animals survived. No evidence of in appropriate diuresis was observed. CONCLUSION: Administration of large amounts of Adsol was not associated wit h hyperglycemia or inappropriate osmotic duiresis in hemorrhaged and resusc itated minipigs. These data suggest that fewer physiologic changes may be a ssociated with the massive transfusion of AS-1 RBCs than with that of CPDA- 1 whole blood.