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Media type:
E-Article
Title:
Hemodynamic response after hypovolemic shock and resuscitation with low‐volume 6% hetastarch (HS) and high‐volume lactated Ringer's (LR) solution
Contributor:
Nunez, Fiesky A.;
Kislukin, V.;
Smith, T. L.;
Callahan, M. F.;
Burnett, L.;
VanDyke, M. E.
Description:
Treatment of hypovolemia is a severe medical problem. HS is thought to be best, each ml restores 1.6ml of circulating volume (CV) while 1 ml of LR restores 0.25ml of CV. Researchers use HS in a volume equal to shed blood and 3:1 resuscitation with LR. HS is not used clinically in that manner and it remains unknown how HS low‐volume resuscitation compares with large volume LR.Male SD rats were anesthetized with isoflurane, instrumented with an arterial catheter for mean arterial pressure (MAP) monitoring and carotid to jugular loop with flowprobes for ultrasound dilution cardiac output readings. Rats were hemorrhaged to a MAP of 40mmHg, maintained for 30 minutes then randomized to receive: 1) HS 6% @ 20% estimated total blood volume or 2) LR @ 3X the volume of shed blood. Hemodynamic parameters were taken at baseline, prior to resuscitation and 2 hours later. HS recovered cardiac function and central blood volume better than LR. However, HS volume expansion was so intense that Hct was so diluted it resulted in a calculated oxygen delivery equal to LR. HS caused a steep increase in HR after 60 minutes, with increased heart work. Such increase in heart work is detrimental to a strained myocardium and could result in early fatigue/failure. HS causes exaggerated osmosis that dilutes Hb and clotting factors, which may exacerbate ischemia and trigger dilutional coagulopathy. US Army uses HS for combat theater resuscitation. Civilian trauma centers still use high‐volume crystalloid resuscitation. This study helps clarify the physiology of low‐volume resuscitation.