Optimization of Lyophilized Plasma for Use in Combat Casualties
Annual rept. 29 Dec 2011-28 Dec 2012
OREGON HEALTH AND SCIENCE UNIV PORTLAND
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Purpose Hemostatic resuscitation is superior to crystalloid resuscitation in restoring blood volume, correcting coagulopathy, minimizing dysfunctional inflammation, and acidosis. Resuscitation with full volume lyophilized plasma LP reduces blood loss, corrects coagulopathy, and decreases inflammation in a swine polytrauma and hemorrhagic shock model. This study compared the efficacy of full volume LP to low volume hypertonic LP. Scope Prior to in vivo testing, in vivo analysis of the plasma was analyzed for electrolyte content, osmolarity and coagulation factor activity. Twenty swine were anesthetized and subjected to a validated model of polytrauma and hemorrhagic shock. They were randomized with lyophilized plasma LP reconstituted to either 100 100LP or half 50LP the original plasma volume. Physiologic data were monitored. Blood loss and hematocrit levels were measured. Coagulation status was evaluated utilizing thrombelastography TEG. Serum and tissue were collected to assess inflammatory markers. Major Findings 50LP had higher electrolyte concentrations, osmolarity, and increased coagulation factor activity levels by volume compared to 100LP. Blood loss, hematocrit, mean arterial pressure and heart rate were not significantly different between groups at any time point. In addition, there were no differences denoted in TEG values. With these finding it is safe to say 50LP is equally effective as 100LP. The smaller volume of fluid necessary to reconstitute the 50LP makes it logistically superior to 100LP and may reduce adverse effects of large fluid volume resuscitation.
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