Optimization of Lyophilized Plasma for Use in Combat Casualties
Annual rept. 29 Dec 2012-28 Dec 2013
OREGON HEALTH AND SCIENCE UNIV PORTLAND
Pagination or Media Count:
Low-volume ascorbic acid buffered reconstituted lyophilized plasma LP provides logistical advantages, reduces the risks of large volume resuscitation, modulates inflammation, and is equally effective for hemostatic resuscitation as full-volume LP. We compared the physiologic effects of resuscitation using LP reconstituted with sterile water LP-SW, lactated Ringer s LP-LR, normal saline LP-NS, and Hextend LP-Hx. Scope Plasma was collected from swine, lyophilized then reconstituted into four test solutions LP-SW, LP-LR, LP-NS, or LP-Hx. Forty swine were anesthetized and subjected to a validated model of polytrauma and hemorrhagic shock including a Grade V liver injury, then randomized to receive one of the four test solutions. Physiologic parameters, blood loss, lactate and hematocrit were followed. Coagulation status was evaluated using thrombelastography. Inflammatory mediator expression was evaluated by RT-PCR and multiplex serum assay. Major Findings Forty animals were included in the study 10 animals per group. One animal died following LP-Hx resuscitation. There was less blood loss in the LP-SW and LP-LR groups compared to the LP-NS and LP-Hx groups p0.05. LP-SW had less early coagulopathic changes by TEG and LP-Hx had persistently elevated INR at the end of the study period p 0.05. Serum IL-6 was lower after 4 hours in the LP-SW group compared to LP-NS p0.05.Resuscitation using low-volume LP-SW and LP-LR buffered with ascorbic acid confers an anti-inflammatory benefit and results in less blood loss. Sterile water is a safe, cost effective, and universally available fluid for creating a low volume hemostatic LP resuscitation solution.
- Anatomy and Physiology
- Medicine and Medical Research