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Intraosseous Erythropoietin for Acute Tissue Protection in Battlefield Casualties Suffering Hypovolemic Shock
Final rept. 4 October 2010-3 October 2012
ROSALIND FRANKLIN UNIV OF MEDICINE AND SCIENCE CHICAGO IL
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The project investigated whether intraosseous administration of erythropoietin EPO during hemorrhagic shock could ameliorate organ injury and facilitate initial resuscitation and subsequent survival. Three series of 24 pigs each were completed, with the pigs randomized 11 to receive EPO or NaCl intraosseously at the onset of hemorrhagic shock. In the first series, 50 of the blood volume BV was removed triggering an adaptive response that maintained O2 consumption close to baseline levels yielding a survival rate of 83 at 72 hours. In the second series, 65 of the BV was removed exhausting the adaptive response and markedly reducing resuscitability to 25. In the third series, also removing 65 of the BV, vasopressin was given during hemorrhagic shock as initial bolus 0.04 Ukg followed by infusion 0.04 Ukg-min-1, dramatically increasing initial resuscitability to 92 and subsequent 72-hour survival to 83. EPO attenuated increases in arterial blood lactate and favored higher mean aortic pressure but without effects on post-resuscitation organ function or survival. Further analysis of the vasopressin effect using the second series as control showed that in addition to increasing mean aortic pressure, vasopressin concomitantly increased cardiac index p 0.022 with a statistically insignificant trend towards higher O2 consumption and lower arterial lactate. These effects suggest that vasopressin - in addition to its arterial vasoconstrictive effect - increased venous tone enhancing venous return and the corresponding forward blood flow by translocating blood from capacitance vessels into the effective circulating volume. Work is planned to examine the effects vasopressin and EPO under conditions of greater hemorrhagic shock severity.
APPROVED FOR PUBLIC RELEASE