Barajas Matthew B, Oyama Takuro, Walter Miriam J K, Shiota Masakazu, Li Zhu, Riess Matthias L
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Department of Anesthesiology, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN 37212, USA.
Life (Basel). 2025 Mar 22;15(4):522. doi: 10.3390/life15040522.
Classical teaching dictates that damage control resuscitation is ideally implemented within the first or 'golden' hour after trauma-related hemorrhage. Given the heterogeneity of trauma, varied models must be utilized to guide ongoing investigation. We sought to determine exactly what happens during the 'golden hour' by varying hemorrhage and down times and mimicking venous or arterial bleeding while varying oxygen therapy, a readily available pre-hospital intervention, on survival in a small-animal rodent model.
Rats were bled by 40% of their blood volume over 30 or 60 min, with varied 'down-times' of 30, 45, or 60 min. FO was administered at 21% or 40%, mimicking nasal cannula. Multiple linear regression was performed between the independent variables and each measured outcome. Sub-group analyses were stratified by survival.
There was no statistically significant variation in end-organ insult (lactate), cardiac functioning (cardiac output or left ventricle fractional area of change), mean arterial pressure at end experiment, survival, or survival times among the groups.
This study adds to the data against an all-encompassing golden hour, as even a rapid hemorrhage with long down time did not decrease survival. Furthermore, we add to the body of literature in this field by examining cardiac markers of injury with transthoracic echocardiography.
传统教学认为，损伤控制复苏理想情况下应在创伤性出血后的第一个或“黄金”小时内实施。鉴于创伤的异质性，必须采用多种模型来指导正在进行的研究。我们试图通过改变出血情况和停工期，并模拟静脉或动脉出血，同时改变氧气疗法（一种易于获得的院前干预措施），来确定在“黄金小时”内到底会发生什么，这一研究是在一种小型啮齿动物模型上进行的，观察其对生存的影响。
大鼠在30或60分钟内失血40%，停工期分别为30、45或60分钟。以21%或40%的氧浓度给予氧气，模拟鼻导管给氧。对自变量与每个测量结果进行多元线性回归分析。亚组分析按生存情况进行分层。
各实验组之间在终末器官损伤（乳酸水平）、心脏功能（心输出量或左心室变化分数面积）、实验结束时的平均动脉压、生存率或生存时间方面，均无统计学上的显著差异。
本研究进一步提供数据反对存在一个涵盖所有情况的黄金小时这一观点，因为即使是长时间停工期的快速出血也并未降低生存率。此外，我们通过经胸超声心动图检查心脏损伤标志物，为该领域的文献增添了内容。
