Intraosseous Erythropoietin for Acute Tissue Protection in Battlefield Casualties Suffering Hypovolemic Shock
Annual rept. 4 Oct 2012-3 Oct 2013
ROSALIND FRANKLIN UNIV OF MEDICINE AND SCIENCE CHICAGO IL
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The project compared in a swine model of hemorrhagic shock HS the effects of vasopressin VP infusion and low-volume fluid resuscitation using normal saline NS on 72 hour survival, with erythropoietin EPO administration and HS severity as confounders. Twenty-four male pigs 36-41 kg were anesthetized with isoflurane and nitrous oxide in oxygen and instrumented to assess hemodynamic function and advance a 23-F cannula into the right atrium for blood withdrawal BW and blood reinfusion using a custom developed system that allowed modeling spontaneous bleeding as a mono-exponential decay function. Twenty-four pigs were randomized 21 to receive an intraosseous infusion of VP 0.04 Ukg min-1 or vehicle control starting 7 minutes into BW until the start of blood reinfusion at minute 210. Pigs were also randomized 11 to receive NS half the amount of BW or no fluids. Pigs assigned to VP were also randomized 11 to EPO 1,200 Ukg or vehicle control and to have 65 or 75 of their blood volume withdrawn. Randomization proceeded by blocks ensur-ing balanced distribution in all the subsets. Survival analysis to 72 hours showed that survival was influenced by VP and NS but not by EPO or HS severity with the highest survival rate in the group VP-NS 100 followed by VP-noNS 37.5, noVP-NS 25, and noVP-noNS 0 with a high overall statistical significance p0.009 by the log-rank test with each subset different than VP-NS by the Holm-Sidak s test. Accordingly, these findings support an approach to the initial management of severe HS in the field that entails early initiation of VP infusion through the intraosseous route followed by low-volume fluid resuscitation e.g., small boluses of normal saline.
- Medicine and Medical Research