Je. Manning et al., Selective aortic arch perfusion with hemoglobin-based oxygen carrier-201 for resuscitation from exsanguinating cardiac arrest in swine, CRIT CARE M, 29(11), 2001, pp. 2067-2074
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.