A. D. Jung1, L. Friend1, S. Stevens-Topie1, R. Schuster1, C. C. Caldwell1, T. A. Pritts1 1University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA
Introduction: Clinical practice guidelines for resuscitation strategies are well established for either isolated hemorrhagic shock or large burn injuries. A one-to-one resuscitation with packed red blood cells and fresh frozen plasma (1:1) is standard for hemorrhagic shock. The use of crystalloids, such as Ringer’s Lactate (LR), is standard for large burn injury resuscitation. In a military setting, patients frequently sustain combined hemorrhage and burn injury, but the optimal fluid resuscitation strategy in this setting is unknown. We hypothesized that a resuscitation strategy that utilizes both crystalloid and blood products improves survival following hemorrhagic shock and burn injury.
Methods: Male mice aged 8-10 weeks (n=7) were anesthetized with pentobarbital and subjected to a 30% full thickness scald injury to their dorsal surface. Immediately following the burn, mice received either no crystalloid resuscitation or 1.5 mL of 0.9% normal saline administered intraperitoneally. The mice then underwent femoral artery cannulation and hemorrhage to a systolic blood pressure of 25 mmHg for 30 minutes. Mice were then resuscitated to a target blood pressure with either lactated Ringer’s solution or a 1 to 1 ratio of packed red blood cells to plasma. Survival was determined and serum was collected at 1 and 4 hours post-resuscitation for electrolyte, and cytokine analysis.
Results: Mice that underwent resuscitation with LR or 1:1 alone died soon after injury (LR: 1.6±0.4 h, 1:1: 2.3±1.2 h). The addition of intraperitoneal saline provided a significant survival advantage within resuscitation groups (NS+LR: p<0.0001 ; NS+1:1: p=0.0001). There was no significant difference in survival times between mice that received NS then LR or 1:1 (8.8±9.4 h vs. 12.0±10.3 h ; p=0.3). At 4 hours, mice that received NS then 1:1 demonstrated less severe metabolic acidosis compared to mice that received NS then LR (p<0.01).
Conclusion: In the setting of a simultaneous hemorrhagic shock and large burn injury, a combined resuscitation strategy with crystalloid and blood products resulted in improved survival when compared to either strategy alone. The administration of blood products improved metabolic acidosis during the resuscitation period.
