Whole Blood and Hextend: Bookends of Modern Tactical Combat Casualty Care Field Resuscitation and Starting Point For Multi-functional Resuscitation Fluid Development.

Sheppard FR, Mitchell TA, Macko AR, Fryer DM, Schaub LJ, Ozuna KM, Glaser JJ

J Trauma Acute Care Surg. 2017 Dec 20

 

BACKGROUND: Hemorrhage is the leading cause of preventable death in traumatically injured civilian and military populations. Pre-hospital resuscitation largely relies on crystalloid and colloid intra-vascular expansion, as whole blood and component blood therapy are logistically arduous. In this experiment, we evaluated the bookends of Tactical Combat Casualty Care Guidelines recommendations of pre-hospital resuscitation with Hextend and whole blood in a controlled hemorrhagic shock model within non-human primates, as means of a multi-functional resuscitative fluid development.

METHODS: In the non-human primate, a poly-trauma model was utilized, consisting of a musculoskeletal injury (femur fracture), soft tissue injury (15cm laparotomy), and controlled hemorrhage to a mean arterial pressure of 20 mmHg, demarcating the beginning of the shock period. Animals were randomized to pre-hospital interventions of whole blood or Hextend at T=0 minutes, and at T=90 minutes definitive surgical interventions and balanced sanguineous damage control resuscitation could be implemented. All animals were euthanized at T=480 minutes. Data are expressed as mean±SEM; significance, p<0.05.

RESULTS: No significant differences in survival, 83% vs. 100%, p=0.3), tissue perfusion (EtCO2 & StO2) or endpoints of resuscitation (base deficit, lactate, pH) between Hextend and whole blood were identified. Secondly, whole blood compared to Hextend demonstrated significantly earlier normalization of clot formation time, maximal clot firmness, and α angle.

CONCLUSION: A future multi-functional resuscitative fluid including an asanguineous, oncotic, non-oxygen carrying component to facilitate intra-vascular volume expansion and a component with synthetic coagulation factors and fibrinogen to deter coagulopathy may show equivalence to whole blood.

STUDY TYPE: Translational animal model LEVEL OF EVIDENCE: N/A.