From the United States Air Force (R.M.P., D.R., J.M.), Clinical Resuscitation, Emergency Science, Triage and Toxicology (CRESTT); United States Air Force (M.C., A.A.M.), 59th Medical Wing, En route Care Research Center, Lackland AFB; Department of Emergency Medicine (J.M.), Brooke Army Military Medical Center; United States Army Institute of Surgical Research (USAISR) (J.M.), Ft Sam Houston, Texas; and F. Edward Hébert School of Medicine (J.M.), Uniformed Services University, Bethesda, Maryland.
J Trauma Acute Care Surg. 2023 Aug 1;95(2S Suppl 1):S120-S128. doi: 10.1097/TA.0000000000004049. Epub 2023 May 17.
Traumatic hemorrhage is the leading cause of preventable death in military environments. Treatment with resuscitative fluids and blood components is based on availability, thus, frequently unavailable in the prehospital setting, due to lack of resources and costs. Hydroxocobalamin (HOC), increases blood pressure via nitric oxide scavenging. We evaluated HOC as a resuscitation fluid, in two swine hemorrhage models. Our objectives were to (1) evaluate whether HOC treatment following hemorrhagic shock improves hemodynamic parameters and (2) determine whether those effects are comparable to whole blood (WB) and lactated ringers (LR).
Yorkshire swine (S us scrofa ) (n = 72) were used in models of controlled hemorrhage (CH) (n = 36) and uncontrolled hemorrhage (UH) (n = 36). Randomized animals received treatment with 500 mL of either WB, LR, HOC (150 mg/kg), followed by a six-hour observation (n = 6 each group). Survival, hemodynamics, blood gases (ABGs) and chemistries were collected. Data reported as mean ± standard error of the mean and statistical analysis by ANOVA ( p < 0.05).
Blood loss for CH was 41% ± 0.02 versus 33% ± 0.07 for UH. For CH, HOC treatment maintained higher systolic blood pressure (sBP, mm Hg) compared with WB and LR (72 ± 1.1; 60 ± 0.8; 58 ± 1.6; respectively). Heart rate (HR), cardiac output (CO), Sp o2 and vascular resistance were comparable with WB and LR. The ABG values were comparable between HOC and WB. For UH, HOC treatment maintained sBP levels comparable to WB and higher than LR (70 ± 0.9; 73 ± 0.5; 56 ± 1.2). HR, CO, Sp o2 , and systemic vascular resistance were comparable between HOC and WB. Survival, hemodynamics, blood gases were comparable between HOC and WB. No survival differences were found between cohorts.
Hydroxocobalamin treatment improved hemodynamic parameters and Ca 2+ levels compared with LR and equivalent to WB, in both models. Hydroxocobalamin may be a viable alternative when WB is not available.
创伤性出血是军事环境中可预防死亡的主要原因。复苏液和血液成分的治疗基于可用性，因此，由于资源和成本的缺乏，在院前环境中经常无法使用。羟钴胺（HOC）通过清除一氧化氮来增加血压。我们评估了 HOC 作为一种复苏液，在两种猪出血模型中。我们的目的是：（1）评估出血性休克后 HOC 治疗是否改善血流动力学参数，（2）确定这些效果是否与全血（WB）和乳酸林格氏液（LR）相当。
使用约克夏猪（S us scrofa ）（n = 72）进行控制性出血（CH）（n = 36）和非控制性出血（UH）（n = 36）模型。随机动物接受 500 mL 以下治疗：WB、LR、HOC（150 mg/kg），随后进行 6 小时观察（每组 n = 6）。收集生存、血流动力学、血气（ABG）和化学物质。数据表示为平均值±平均值的标准误差，通过 ANOVA 进行统计学分析（p < 0.05）。
CH 的失血量为 41%±0.02%，而 UH 的失血量为 33%±0.07%。对于 CH，HOC 治疗维持的收缩压（sBP，mmHg）高于 WB 和 LR（72±1.1；60±0.8；58±1.6；分别）。心率（HR）、心输出量（CO）、Sp o2 和血管阻力与 WB 和 LR 相当。ABG 值在 HOC 和 WB 之间相当。对于 UH，HOC 治疗维持的 sBP 水平与 WB 相当，高于 LR（70±0.9；73±0.5；56±1.2）。HR、CO、Sp o2 和全身血管阻力在 HOC 和 WB 之间相当。HOC 和 WB 之间的生存率、血流动力学、血气无差异。两组间未发现生存差异。
与 LR 相比，HOC 治疗可改善血流动力学参数和 Ca 2+ 水平，与 WB 相当。在无法获得 WB 的情况下，HOC 可能是一种可行的替代方法。
