Testing of Blood Products in a Polytrauma Model: Results of a Multi-Institutional Randomized Preclinical Trial.

摘要

Introduction: Trauma-induced coagulopathy, acidosis, and hypothermia form a lethal triad that is difficult to treat and is associated with extremely high mortality. This study was performed at three academic centers to evaluate whether resuscitation with blood components could reverse the coagulopathy in a complex polytrauma model. Methods: Yorkshire swine (40 + or - 5 kg) were subjected to a three-phase protocol: (a) "Prehospital phase" = femur fracture, hemorrhage (60% blood volume), and 30 minutes shock infusion of saline (3 shed blood) induction of hypothermia (33 Degrees C); (b) Early hospital phase grade V liver injury; and (c) Operative phase liver packing. After liver packing, the animals (n = 60) were randomized to the following groups: (1) Sham- instrumentation and anesthesia without hemorrhage/injuries, (2) fresh whole blood (FWB), (3) 6% hetastarch (Hextend), (4) fresh frozen plasma/packed RBCs in 1:1 ratio (1:1 FFP/PRBC), and (5) FFP alone. Treatment volumes were equal to the volume of shed blood. Hemodynamic and physiologic parameters and coagulation profile (thrombelastography, prothrombin time, activated partial thromboplastin time, international normalized ratio, and platelets) were monitored during the experiment and for 4 hours posttreatment. Results: At the end of prehospital phase, animals had developed significant acidosis (lactate greater than 5 mmol/L and base deficit greater than 9 mmol/L) and coagulopathy. Posttreatment mortality rates were 85% and 0% for the Hextend and blood component treated groups, respectively (p less than 0.05). Hemodynamic parameters and survival rates were similar in groups that were treated with blood products (FWB, FFP, and FFP:PRBC). Animals treated with FFP and Hextend had significant anemia compared with the groups that received red blood cells (FWB and FFP-PRBC). Treatment with FFP and FFP-PRBC corrected the coagulopathy as effectively as FWB, whereas Hextend treatment worsened coagulopathy.