From the Department of Surgery (H.E.H.), Oregon Health and Science University, Portland, Oregon; Department of Emergency Medicine (J.E.M., S.L.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Division of Trauma, Critical Care and Acute Care Surgery (T.L.G., B.H.M., J.D.R.), Oregon Health and Science University, Portland, Oregon.
J Trauma Acute Care Surg. 2019 Aug;87(2):263-273. doi: 10.1097/TA.0000000000002315.
Hemorrhage-induced traumatic cardiac arrest (HiTCA) has a dismal survival rate. Previous studies demonstrated selective aortic arch perfusion (SAAP) with fresh whole blood (FWB) improved the rate of return of spontaneous circulation (ROSC) after HiTCA, compared with resuscitative endovascular balloon occlusion of the aorta and cardiopulmonary resuscitation (CPR). Hemoglobin-based oxygen carriers, such as hemoglobin-based oxygen carrier (HBOC)-201, may alleviate the logistical constraints of using FWB in a prehospital setting. It is unknown whether SAAP with HBOC-201 is equivalent in efficacy to FWB, whether conversion from SAAP to extracorporeal life support (ECLS) is feasible, and whether physiologic derangement post-SAAP therapy is reversible.
Twenty-six swine (79 ± 4 kg) were anesthetized and underwent HiTCA which was induced via liver injury and controlled hemorrhage. Following arrest, swine were randomly allocated to resuscitation using SAAP with FWB (n = 12) or HBOC-201 (n = 14). After SAAP was initiated, animals were monitored for a 20-minute prehospital period prior to a 40-minute damage control surgery and resuscitation phase, followed by 260 minutes of critical care. Primary outcomes included rate of ROSC, survival, conversion to ECLS, and correction of physiology.
Baseline physiologic measurements were similar between groups. ROSC was achieved in 100% of the FWB animals and 86% of the HBOC-201 animals (p = 0.483). Survival (t = 320 minutes) was 92% (11/12) in the FWB group and 67% (8/12) in the HBOC-201 group (p = 0.120). Conversion to ECLS was successful in 100% of both groups. Lactate peaked at 80 minutes in both groups, and significantly improved by the end of the experiment in the HBOC-201 group (p = 0.001) but not in the FWB group (p = 0.104). There was no significant difference in peak or end lactate between groups.
Selective aortic arch perfusion is effective in eliciting ROSC after HiTCA in a swine model, using either FWB or HBOC-201. Transition from SAAP to ECLS after definitive hemorrhage control is feasible, resulting in high overall survival and improvement in lactic acidosis over the study period.
出血性创伤性心搏骤停（HiTCA）的存活率非常低。先前的研究表明，与主动脉球囊阻断复苏和心肺复苏（CPR）相比，选择性主动脉弓灌注（SAAP）联合新鲜全血（FWB）可提高 HiTCA 后自主循环恢复（ROSC）的比率。血红蛋白基氧载体，如血红蛋白基氧载体（HBOC）-201，可能缓解在院前环境中使用 FWB 的后勤限制。目前尚不清楚 SAAP 联合 HBOC-201 的疗效是否与 FWB 相当，从 SAAP 转为体外生命支持（ECLS）是否可行，以及 SAAP 治疗后生理紊乱是否可逆。
26 头（79±4kg）猪接受麻醉并进行 HiTCA，通过肝损伤和控制性出血诱导。心搏骤停后，猪随机接受 SAAP 联合 FWB（n=12）或 HBOC-201（n=14）复苏。SAAP 开始后，在进行 40 分钟损伤控制性手术和复苏阶段之前，动物监测 20 分钟的院前期，然后进行 260 分钟的重症监护。主要结局包括 ROSC 率、存活率、转为 ECLS 和生理纠正。
两组的基础生理测量值相似。FWB 组 100%和 HBOC-201 组 86%的动物实现 ROSC（p=0.483）。FWB 组的存活时间（t=320 分钟）为 92%（11/12），HBOC-201 组为 67%（8/12）（p=0.120）。两组均成功转为 ECLS。两组的乳酸峰值均在 80 分钟，HBOC-201 组在实验结束时明显改善（p=0.001），而 FWB 组则无显著改善（p=0.104）。两组的峰值或终末乳酸之间无显著差异。
在猪 HiTCA 模型中，使用 FWB 或 HBOC-201 进行选择性主动脉弓灌注均可有效引发 ROSC。在明确出血控制后，从 SAAP 过渡到 ECLS 是可行的，这导致整体存活率高，乳酸酸中毒在研究期间得到改善。
