Elsevier

Annals of Emergency Medicine

Volume 21, Issue 9, September 1992, Pages 1077-1085
Annals of Emergency Medicine

Laboratory investigation
Use of hypertonic saline/dextran versus lactated ringer's solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine

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Study objective:

We tested the hypothesis that following aortotomy, administration of hypertonic saline/dextran increases hemorrhage and mortality. We also compared hypertonic saline/dextran with the standard therapy of attempting to replace three times the amount of lost blood with lactated Ringer's solution.

Design:

In this model of uncontrolled arterial hemorrhage resulting from aortotomy, 24 anesthetized Yorkshire swine underwent splenectomy, stainless steel wire placement in the infrarenal aorta, and instrumentation with Swan-Ganz and carotid artery catheters. The wire was pulled, producing a 5-mm aortotomy and spontaneous intraperitoneal hemorrhage.

Interventions:

The animals were randomly assigned to one of three study groups: control; hypertonic saline/dextran group in which six minutes after aortotomy a 4-mL/kg mixture of IV 7.5% NaCl and 6% Dextran-70 was given over one minute; or lactated Ringer's group in which six minutes after aortotomy 80 mL/kg IV lactated Ringer's was given over nine minutes.

Measurements and main results:

The volume of hemorrhage and the mortality rate in hypertonic saline/dextran-treated animals were significantly greater than in the nonresuscitated controls (1,340 ± 230 mL versus 783 ± 85 mL and five of eight versus zero of eight, respectively; P < .05). Although the mortality rate in the lactated Ringer's group was not significantly different from the hypertonic saline/dextran group, survival time was significantly shorter than in the hypertonic saline/dextran group.

Conclusion:

In this model of uncontrolled hemorrhage, immediate IV administration of hypertonic saline/dextran significantly increased hemorrhage volume and mortality. However, the accentuation of hemorrhage and reduction in survival were not as great as that produced by the standard practice of attempting to replace the lost blood with three times that volume of lactated Ringer's.

References (31)

  • ManingasPA et al.

    Small volume infusion of 7.5% NaCl in 6% Dextran-70 for treatment of severe hemorrhagic shock in swine

    Ann Emerg Med

    (1986)
  • ManingasPA et al.

    Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension

    Am J Surg

    (1989)
  • WadeCE et al.

    Resuscitation of conscious pigs following hemorrhage: Comparative efficacy of small-volume resuscitation with normal saline, 7.5% NaCl, 6% Dextran-70, and 7.5% NaCl in 6% Dextran-70

    Circ Shock

    (1989)
  • VelascoIT et al.

    Hypertonic and hyperoncotic resuscitation from severe hemorrhagic shock in dogs: A comparative study

    Crit Care Med

    (1989)
  • ManingasPA

    Resuscitation with 7.5% NaCl in 6% Dextran-70 during hemorrhagic shock in swine: Effects on organ blood flow

    Crit Care Med

    (1987)
  • KramerGC et al.

    Small-volume resuscitation with hypertonic saline dextran solution

    Surgery

    (1986)
  • HolcroftJW et al.

    3% NaCl and 7.5% NaCI/Dextran-70 in the resuscitation of severely injured patients

    Ann Surg

    (1987)
  • HolcroftJW et al.

    Use of a 7.5 NaCI/6% Dextran-70 solution in the resuscitation of injured patients in the emergency room

  • BellamyRF

    The cause of death in conventional land warfare: Implications for combat casualty care research

    Milit Med

    (1984)
  • MattoxKL et al.

    Prospective randomized evaluation of antishock MAST in post-traumatic hypotension

    J Trauma

    (1986)
  • MillesG et al.

    Experimental uncontrolled arterial hemorrhage

    Surgery

    (1966)
  • ShaftanGW et al.

    The effect of transfusion and of certain hemodynamic factors on the spontaneous control of arterial hemorrhage

    J Cardiovasc Surg (Torino)

    (1964)
  • HarrisBY et al.

    An experimental study of venous hemostasis

    Surgery

    (1967)
  • GrossD et al.

    Is hypertonic saline resuscitation safe in “uncontrolled” hemorrhagic shock?

    J Trauma

    (1988)
  • GrossD et al.

    Quantitative measurement of bleeding following hypertonic saline therapy in “uncontrolled” hemorrhagic shock

    J Trauma

    (1989)

    • Cited by (0)

    The opinions and assertions contained herein are the private views of authors and are not to be construed as official nor do they reflect the views of the Department of the Army or the Department of Defense (AR 360-5).

    The studies described in this report were reviewed and approved by the Institutional Review Committee/Animal Care and Use Committee at Letterman Army Institute of Research. The manuscript was peer-reviewed for compliance before submission for publication. In conducting the research herein, the investigators adhered to the “Guide for the Care and Use of Laboratory Animals,”DHEW Publication (NIH) 85-23.

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