Multifaceted Benefit of Whole Blood Versus Lactated Ringer's Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice

Benjamin E. Zusman, University of Pittsburgh School of Medicine, Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
Patrick M. Kochanek, Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Zachary S. Bailey, Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Lai Yee Leung, Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Vincent A. Vagni, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
David O. Okonkwo, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Ava M. Puccio, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Lori A. Shutter, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Keri L. Janesko-Feldman, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Janice S. Gilsdorf, Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Deborah A. Shear, Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Ruchira M. Jha, Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. ruchirajha@gmail.com.Follow

Document Type

Article

Abstract

BACKGROUND: Despite increasing use in hemorrhagic shock (HS), whole blood (WB) resuscitation for polytrauma with traumatic brain injury (TBI) is largely unexplored. Current TBI guidelines recommend crystalloid for prehospital resuscitation. Although WB outperforms lactated Ringer's (LR) in increasing mean arterial pressure (MAP) in TBI + HS models, effects on brain tissue oxygenation (PbtO), and optimal MAP remain undefined. METHODS: C57BL/6 mice (n = 72) underwent controlled cortical impact followed by HS (MAP = 25-27 mmHg). Ipsilateral hippocampal PbtO (n = 40) was measured by microelectrode. Mice were assigned to four groups (n = 18/group) for "prehospital" resuscitation (90 min) with LR or autologous WB, and target MAPs of 60 or 70 mmHg (LR, WB, LR, WB). Additional LR (10 ml/kg) was bolused every 5 min for MAP below target. RESULTS: LR requirements in WB (7.2 ± 5.0 mL/kg) and WB (28.3 ± 9.6 mL/kg) were markedly lower than in LR (132.8 ± 5.8 mL/kg) or LR (152.2 ± 4.8 mL/kg; all p < 0.001). WB MAP (72.5 ± 2.9 mmHg) was higher than LR (59.8 ± 4.0 mmHg, p < 0.001). WB MAP (68.7 ± 4.6 mmHg) was higher than LR (53.5 ± 3.2 mmHg, p < 0.001). PbtO was higher in WB (43.8 ± 11.6 mmHg) vs either LR (25.9 ± 13.0 mmHg, p = 0.04) or LR (24.1 ± 8.1 mmHg, p = 0.001). PbtO in WB (40.7 ± 8.8 mmHg) was higher than in LR (p = 0.007). Despite higher MAP in WB vs WB (p = .002), PbtO was similar. CONCLUSION: WB resuscitation after TBI + HS results in robust improvements in brain oxygenation while minimizing fluid volume when compared to standard LR resuscitation. WB resuscitation may allow for a lower prehospital MAP without compromising brain oxygenation when compared to LR resuscitation. Further studies evaluating the effects of these physiologic benefits on outcome after TBI with HS are warranted, to eventually inform clinical trials.

Medical Subject Headings

Animals; Brain Injuries, Traumatic (therapy); Disease Models, Animal; Isotonic Solutions (pharmacology); Mice; Mice, Inbred C57BL; Resuscitation; Ringer's Lactate; Shock, Hemorrhagic (therapy)

Publication Date

6-1-2021

Publication Title

Neurocritical care

E-ISSN

1556-0961

Volume

34

Issue

3

First Page

781

Last Page

794

PubMed ID

32886294

Digital Object Identifier (DOI)

10.1007/s12028-020-01084-1

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