Small volume 7.5% NaCl With 6% dextran-70 or 6% and 10% hetastarch are associated with arrhythmias and death after 60 minutes of severe hemorrhagic shock in the rat in vivo
Letson, Hayley L., and Dobson, Geoffrey P. (2011) Small volume 7.5% NaCl With 6% dextran-70 or 6% and 10% hetastarch are associated with arrhythmias and death after 60 minutes of severe hemorrhagic shock in the rat in vivo. Journal of Trauma, 70 (6). pp. 1444-1452.
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Background: Hypertonic saline solutions in combination with colloids may have some applications in critically ill patients. Our aim was to examine the effects of small volumes (0.7–1 mL/kg intravenous) of 7.5% NaCl with different colloids on cardiac stability, hemodynamics, and mortality after severe hemorrhagic shock.
Methods: Male fed Sprague-Dawley rats (300–450 g, n = 48) were anesthetized and randomly assigned to one of six groups: (1) untreated (bleed only), (2) 7.5% NaCl, (3) 7.5% NaCl/6% dextran-70, (4) 7.5% NaCl/6% hetastarch (HES), (5) 6% HES alone, and (6) 7.5% NaCl/10% HES. Hemorrhagic shock was induced by phlebotomy until the mean arterial pressure (MAP) was 35 mm Hg to 40 mm Hg and continued for 20 minutes until ~40% blood loss. Animals were left in shock for 60 minutes at 34°C. 0.3 mL (<4% of shed blood) was injected as a 10 seconds bolus into the femoral vein. Lead II electrocardiogram, blood pressures, MAP, and heart rate were monitored.
Results: Untreated rats were highly arrhythmogenic with 38% mortality. 7.5% NaCl increased MAP from 39 mm Hg to 44 mm Hg with no severe arrhythmias or mortality. Dextran-70 increased MAP from 38 mm Hg to 49 mm Hg, transiently increased QRS amplitude (1.5 times) and was arrhythmogenic affecting 50% of animals with no deaths. Addition of 6% HES to hypertonic saline resulted in aberrant arrhythmias and 38% mortality. Six percent HES alone was proarrhythmic and led to 38% mortality. 7.5% NaCl with 10% HES resulted in 100% mortality (p < 0.05) from arrhythmias within 5 minutes of resuscitation.
Conclusions: Small volumes of 7.5% NaCl led to fewer arrhythmias and a 2.6 times survival benefit over untreated rats, and a partial resuscitation of MAP into the "permissive range." Dextran-70 or HES in 7.5% NaCl were proarrhythmic and HES led to increased mortality (p < 0.05). Because optimal heart function is critical for successful resuscitation, care should be exercised when using dextran-70 or 6 and 10% HES in small volume hypertonic saline solutions for early hypotensive resuscitation.
|Item Type:||Article (Refereed Research - C1)|
|Keywords:||7.5% NaCl, dextran, hetastarch, HES, trauma, shock, hemorrhagic, small volume, military, battlefield, cardioprotection, arrhythmias, resuscitation, colloids, crystalloid, hypertonic, oncotic, hyperosmotic|
|FoR Codes:||11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110201 Cardiology (incl Cardiovascular Diseases) @ 100%|
|SEO Codes:||92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%|
|Deposited On:||11 Mar 2011 16:36|
|Last Modified:||18 Oct 2013 01:12|
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