Choice of Whole Blood versus Lactated Ringer's Resuscitation Modifies the Relationship between Blood Pressure Target and Functional Outcome after Traumatic Brain Injury plus Hemorrhagic Shock in Mice

Benjamin E. Zusman, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
C Edward Dixon, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Ruchira M. Jha, Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Vincent A. Vagni, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Jeremy J. Henchir, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Shaun W. Carlson, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Keri L. Janesko-Feldman, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Zachary S. Bailey, Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
Deborah A. Shear, Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
Janice S. Gilsdorf, Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
Patrick M. Kochanek, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Document Type

Article

Abstract

Civilian traumatic brain injury (TBI) guidelines recommend resuscitation of patients with hypotensive TBI with crystalloids. Increasing evidence, however, suggests that whole blood (WB) resuscitation may improve physiological and survival outcomes at lower resuscitation volumes, and potentially at a lower mean arterial blood pressure (MAP), than crystalloid after TBI and hemorrhagic shock (HS). The objective of this study was to assess whether WB resuscitation with two different MAP targets improved behavioral and histological outcomes compared with lactated Ringer's (LR) in a mouse model of TBI+HS. Anesthetized mice ( = 40) underwent controlled cortical impact (CCI) followed by HS (MAP = 25-27 mm Hg; 25 min) and were randomized to five groups for a 90 min resuscitation: LR with MAP target of 70 mm Hg (LR), LR, WB, WB, and monitored sham. Mice received a 20 mL/kg bolus of LR or autologous WB followed by LR boluses (10 mL/kg) every 5 min for MAP below target. Shed blood was reinfused after 90 min. Morris Water Maze testing was performed on days 14-20 post-injury. Mice were euthanized (21 d) to assess contusion and total brain volumes. Latency to find the hidden platform was greater versus sham for LR ( < 0.002) and WB ( < 0.007) but not LR or WB. The WB resuscitation did not reduce contusion volume or brain tissue loss. The WB targeting a MAP of 60 mm Hg did not compromise function versus a 70 mm Hg target after CCI+HS, but further reduced fluid requirements ( 0.03). Using LR, higher achieved MAP was associated with better behavioral performance (rho = -0.67,  0.028). Use of WB may allow lower MAP targets without compromising functional outcome, which could facilitate pre-hospital TBI resuscitation.

Medical Subject Headings

Animals; Blood Pressure (drug effects); Blood Transfusion (methods); Brain Injuries, Traumatic (complications, psychology, therapy); Emergency Medical Services; Fluid Therapy; Male; Maze Learning; Mice; Mice, Inbred C57BL; Psychomotor Performance; Resuscitation; Ringer's Lactate (therapeutic use); Shock, Hemorrhagic (complications, psychology, therapy); Treatment Outcome

Publication Date

10-15-2021

Publication Title

Journal of neurotrauma

E-ISSN

1557-9042

Volume

38

Issue

20

First Page

2907

Last Page

2917

PubMed ID

34269621

Digital Object Identifier (DOI)

10.1089/neu.2021.0157

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