Abergel Hilla, Bidder Miri, Ashkenazi Itamar, Reytman Leonid, Alfici Ricardo, Krausz Michael M
Surgical Research Laboratory, Hillel Yaffel Medical Center, Hadera, Israel.
Technion-Israel Institute of Technology, Haifa, Israel.
Rambam Maimonides Med J. 2023 Jan 29;14(1):e0002. doi: 10.5041/RMMJ.10489.
Blunt traumatic brain injury (bTBI) and uncontrolled hemorrhagic shock (UCHS) are common causes of mortality in polytrauma. We studied the influence of fresh frozen plasma (FFP) resuscitation in a rat model with both bTBI and UCHS before achieving hemorrhage control.
The bTBI was induced by an external weight drop (200 g) onto the bare skull of anesthetized male Lewis (Lew/SdNHsd) rats; UCHS was induced by resection of two-thirds of the rats' tails. Fifteen minutes following trauma, bTBI+UCHS rats underwent resuscitation with FFP or lactated Ringer's solution (LR). Eight groups were evaluated: (1) Sham; (2) bTBI; (3) UCHS; (4) UCHS+FFP; (5) UCHS+LR; (6) bTBI+UCHS; (7) bTBI+UCHS+FFP; and (8) bTBI+UCHS+LR. Bleeding volume, hematocrit, lactate, mean arterial pressure (MAP), heart rate, and mortality were measured.
The study included 97 rats that survived the immediate trauma. Mean blood loss up to the start of resuscitation was similar among UCHS only and bTBI+UCHS rats (P=0.361). Following resuscitation, bleeding was more extensive in bTBI+UCHS+FFP rats (5.2 mL, 95% confidence interval [CI] 3.7, 6.6) than in bTBI+UCHS+LR rats (2.5 mL, 95% CI 1.2, 3.8) and bTBI+UCHS rats (1.9 mL, 95% CI 0, 3.9) (P=0.005). Overall mortality increased if bleeding was above 4.5 mL (92.3% versus 8%; P<0.001). Mortality was 83.3% (10/12) in bTBI+UCHS+FFP rats, 41.7% (5/12) in bTBI+UCHS+LR rats, and 64.3% (9/14) in bTBI+UCHS rats.
The bTBI did not exacerbate bleeding in rats undergoing UCHS. Compared to LR, FFP resuscitation was associated with a significantly increased blood loss in bTBI+UCHS rats.
钝性创伤性脑损伤（bTBI）和失血性休克（UCHS）是多发伤致死的常见原因。我们在大鼠模型中研究了在出血控制前新鲜冰冻血浆（FFP）复苏对同时患有bTBI和UCHS的影响。
通过将外部重物（200克）落在麻醉的雄性Lewis（Lew/SdNHsd）大鼠裸露的颅骨上来诱导bTBI；通过切除大鼠三分之二的尾巴来诱导UCHS。创伤后15分钟，bTBI+UCHS大鼠接受FFP或乳酸林格氏液（LR）复苏。评估了八组：（1）假手术组；（2）bTBI组；（3）UCHS组；（4）UCHS+FFP组；（5）UCHS+LR组；（6）bTBI+UCHS组；（7）bTBI+UCHS+FFP组；（8）bTBI+UCHS+LR组。测量出血量、血细胞比容、乳酸、平均动脉压（MAP）、心率和死亡率。
该研究纳入了97只在即时创伤中存活的大鼠。仅UCHS组和bTBI+UCHS组大鼠在复苏开始前的平均失血量相似（P=0.361）。复苏后，bTBI+UCHS+FFP组大鼠的出血（5.2毫升，95%置信区间[CI]3.7，6.6）比bTBI+UCHS+LR组大鼠（2.5毫升，95%CI1.2，3.8）和bTBI+UCHS组大鼠（1.9毫升，95%CI0，3.9）更广泛（P=0.005）。如果出血量超过4.5毫升，总体死亡率会增加（92.3%对8%；P<0.001）。bTBI+UCHS+FFP组大鼠的死亡率为83.3%（10/12），bTBI+UCHS+LR组大鼠为41.7%（5/12），bTBI+UCHS组大鼠为64.3%（9/14）。
bTBI并未加重患有UCHS大鼠的出血。与LR相比，FFP复苏与bTBI+UCHS大鼠的失血量显著增加有关。
