Bovine hemoglobin-based oxygen carrier (HBOC-201) for resuscitation of uncontrolled, exsanguinating liver injury in swine

In the setting of rapidly exsanguinating hemorrhage, resuscitation with int ravenous (i.v.) crystalloid solution may not sustain survival before: avail ability of allogenic blood transfusion and surgery. This study tested the h ypothesis that bovine hemoglobin-based oxygen carrier, HBOC-201, would impr ove resuscitation and extend early survival from exsanguinating hemorrhage. This study simulated the prehospital scenario of rapidly exsanguinating he morrhage with prolonged prehospital time and lack of blood availability. Se vere hemorrhagic shock was induced in swine by using multiple liver lacerat ions. At 9 min after the onset of bleeding, swine were randomized to receiv e approximately 10 mL/kg/min of i.v. lactated Ringer's solution (n = 10) or HBOC-201 (n = 7) to achieve a mean aortic pressure (MAP) of 60 mmHg. There after, infusion rate was adjusted to maintain MAP at 60 mmHg for up to 2 h. All animals were initially successfully resuscitated. The results showed 2 -h survival was 1 of 10 with lactated Ringer's and 7 of 7 with HBOC-201 (P = 0.0004). Nine lactated Ringer's swine had cardiovascular collapse at 36 r t 10 min. Lactate at 30 min was 18 +/- 3 mmol/L with lactated Ringer's and 12 +/- 2 mmol/L with HBOC-201 (P < 0.05). Hematocrit was < 1% in 9 of 10 la ctated Ringer's and 6 of 7 HBOC-201 animals. These data indicate that HBOC- 201 improved early survival and stabilized hemodynamic and metabolic parame ters vs. lactated Ringer's in this swine model of liver injury with uncontr olled, lethal hemorrhage that simulates the prehospital care environment wh ere allogenic blood is unavailable.