Albumin Saturated with Fatty Acids Prevents Decompensation in a Rat Hemorrhagic Shock Model with Tourniquet and Hypotensive Resuscitation
59th MDW San Antonio United States
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Decompensation is a major pre-hospital threat to survival from traumahemorrhage shock THS after controlling bleeding. We recently showed higher than expected mortality from a combat-relevant rat model of THS 27 mlkg hemorrhage with tourniquet TQ and permissive hypotensive resuscitation PHR with Plasmalyte. Mortality and fluid requirements were reduced by resuscitation with 25 percent albumin pre-saturated with oleic acid OA-sat compared to fatty-acid FA-free albumin or Plasmalyte. The objective of this follow-up study was to analyze the role of decompensation in those outcomes. We observed two forms of decompensation slow accelerating fluid volumes needed to maintain blood pressure and acute continuous fluid administration unable to prevent pressure drop. Combined incidence of decompensation was 71 percent. Acute decompensations caused 21 of 22 total deaths observed by 3 h and began as slow decompensations. Prior to transition from slow to acute, acute decompensators were distinguishable from stable animals by their diastolic pressure response to fluids. Decompensation was not due to loss of cardiac performance. Acute decompensators had significantly lower heart rate and diastolic blood pressure variability and high-frequency spectral power. Colloid administration FA-free albumin to increase oncotic pressure added to vascular volume but only delayed the need for high fluid volumes to maintain pressure. In contrast, OA-sat albumin rats maintained pressure with less fluid, in line with decreased decompensation. Our findings suggest acute decompensation may be common after trauma and severe hemorrhage treated with TQ and PHR and that OA-sat albumin may benefit early survival and reduce transfusion volume by preventing decompensation.
- Medicine and Medical Research