Selective aortic arch perfusion with hemoglobin-based oxygen carrier-201 for resuscitation from exsanguinating cardiac arrest in swine

Objective., The prospects for resuscitation after blunt traumatic cardiac a rrest are dismal. selective aortic arch perfusion (SAAP) with a hemoglobin- based oxygen carrier (HBOC-201) offers a potentially effective therapy. Thi s study evaluated the acute cardiovascular and metabolic effects of SAAP wi th HBOC-201 in an exsanguination model of cardiac arrest. Design: Randomized, controlled, laboratory investigation. Setting. University research laboratory. Subjects. Domestic swine, 25-39 kg. Interventions., Partial resection of four liver lobes rapidly led to profou nd hemorrhagic shock and subsequent cardiac arrest at 10-13 mins. At 15 min s, swine were randomized to receive either SAAP with oxygenated lactated Ri nger's (LR) solution (n = 6) or SAAP with oxygenated HBOC-201 (n = 6) at a rate of 10 mL(.)kg(-1.)min(-1) until return of spontaneous circulation with a mean aortic pressure of 60 mm Hg (8.0 kPa) was achieved. Epinephrine (0. 005 mg/kg) was given via intra-aortic route every 30 secs as needed to prom ote return of spontaneous circulation beginning at 18 mins after onset of l iver injury (3 mins after beginning SAAP). Measurements and Main Results: Mean aortic pressure, cardiac output, total blood loss, and time of arrest were similar for both groups before SAAP the rapy. in the SAAP-HBOC group, return of spontaneous circulation with a sust ained mean aortic pressure of 60 mm Hg (8.0 kPa) was achieved in six of six swine at 1.9 0.3 mins of SAAP, and none of these swine required epinephrin e. In the SAAP-LR group, no swine (from a total of six) achieved return of spontaneous circulation before intra-aortic epinephrine administration, and only two of six swine had brief return of spontaneous circulation with an mean aortic pressure of 60 mm Hg (8.0 kPa) after intra-aortic epinephrine t hat was sustained for < 10 mins. One-hour survival was five of six in the S AAP-HBOC group and none of six in the SAAP-LR group (p < .05, Fisher's exac t test). Conclusion. SAAP with oxygenated HBOC-201 rapidly restored viable cardiovas cular function after exsanguinating cardiac arrest in this swine model of l iver injury with profound hemorrhagic shock.