Resuscitation of severe uncontrolled hemorrhage: 7.5% sodium chloride/6% dextran 70 vs 0.9% sodium chloride

Objectives: Resuscitation studies of hypertonic saline using controlled and uncontrolled hemorrhage models yield conflicting results with regard to ef ficacy. These disparate results reflect the use of models and resuscitation regimens that are not comparable between studies. This study evaluated the effects of comparable and clinically relevant resuscitation regimens of 7. 5% sodium chloride/6% dextran 70 (HSD) and 0.9% sodium chloride (NS) in a n ear-fatal uncontrolled hemorrhage model. Methods: Thirty-six swine (14.2 to 21.4 kg) with 4-mm aortic tears were bled to a pulse pressure of 5 mm Hg ( 40-45 mL/kg). The animals were resuscitated with either NS or HSD administe red in volumes that provided equivalent sodium loads at similar rates. Grou p II (n = 12) was resuscitated with 80 mL/kg of NS at a rate of 4 mL/kg/min . Group III (n = 12) received 9.6 mL/kg of HSD at a rate of 0.48 mL/kg/min. In both groups, crystalloid resuscitation was followed by shed blood infus ion (30 mL/kg) at a rate of 2 mL/kg/min. Group I (controls; n = 12) were no t resuscitated. Results: One-hour mortality was significantly greater in gr oup I (92%) as compared with group II (33%) and group III (33%) (Fisher's e xact test; p = 0.004). Intraperitoneal hemorrhage was significantly greater in group II (34 +/- 20 mL/kg) and group III (31 +/- 13 mL/kg) as compared with group I (5 +/- 2 mL/kg) (ANOVA; p < 0.05). There was no significant di fference in hemodynamic parameters between groups II and III. Conclusion: I n this model of severe uncontrolled hemorrhage, resuscitation with HSD or N S, administered in volumes that provided equivalent sodium loads at similar rates, had similar effects on mortality, hemodynamic parameters, and hemor rhage from the injury site.