Document Detail


Resuscitation from hemorrhagic shock using polymerized hemoglobin compared to blood.
MedLine Citation:
PMID:  24418449     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The development of an alternative to blood transfusion to treat severe hemorrhage remains a challenge, especially in far forward scenarios when blood is not available. Hemoglobin level (Hb)-based oxygen (O2) carriers (HBOCs) were developed to address this need. Hemopure (HBOC-201, bovine Hb glutamer-250; OPK Biotech, Cambridge, MA), one such HBOC, has been approved for clinical use in South Africa and Russia. At the time of its approval, however, few studies aimed to understand Hemopure's function, administration, and adverse effects compared to blood. We used intravital microscopy to study the microcirculation hemodynamics (arteriolar and venular diameters and blood flow and functional capillary density [FCD]) and oxygenation implications of Hemopure administration at different Hb concentrations-4, 8, and 12 gHb/dL-compared to fresh blood transfusion during resuscitation from hemorrhagic shock. Experiments were performed in unanesthetized hamsters instrumented with a skinfold window chamber, subjected to hemorrhage (50% of the blood volume), followed by 1-hour hypovolemic shock and fluid resuscitation (50% of the shed volume). Our results show that fluid resuscitation with Hemopure or blood restored systemic and microvascular parameters. Microcirculation O2 delivery was directly correlated with Hemopure concentration, although increased vasoconstriction was as well. Functional capillary density reflected the balance between enhanced O2 transport and reduced blood flow: 12 gHb/dL of Hemopure and blood decreased FCD compared to the lower concentrations of Hemopure (P < .05). The balance between O2 transport and tissue perfusion can provide superior resuscitation from hemorrhagic shock compared to blood transfusion by using a low Hb concentration of HBOCs relative to blood.
Authors:
Daniel Ortiz; Marcelo Barros; Su Yan; Pedro Cabrales
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2013-12-07
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  32     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2014 Mar 
Date Detail:
Created Date:  2014-03-10     Completed Date:  2014-04-28     Revised Date:  2014-06-10    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  248-55     Citation Subset:  IM    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Animals
Biological Markers / blood
Blood Flow Velocity
Blood Substitutes / therapeutic use*
Cricetinae
Dose-Response Relationship, Drug
Erythrocyte Transfusion*
Fluid Therapy / methods*
Hemoglobins / therapeutic use*
Male
Microcirculation
Oxygen / blood
Resuscitation / methods*
Shock, Hemorrhagic / blood,  drug therapy*,  physiopathology,  therapy
Grant Support
ID/Acronym/Agency:
P01 HL110900/HL/NHLBI NIH HHS; R01 HL052684/HL/NHLBI NIH HHS; R01 HL062318/HL/NHLBI NIH HHS; R01 HL062318/HL/NHLBI NIH HHS; R01 HL064395/HL/NHLBI NIH HHS; R01 HL064395/HL/NHLBI NIH HHS; R01 HL52684/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Blood Substitutes; 0/HBOC 201; 0/Hemoglobins; S88TT14065/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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