“SCOOP AND RUN” OR STABILIZE HEMORRHAGIC SHOCK WITH NORMAL SALINE OR SMALL-VOLUME HYPERTONIC SALINE?

Abstract

The controversy over a policy of “scoop and run” or stabilizing hemorrhagic shock when evacuation time is short has not yet been settled. Small volumes of hypertonic saline have been suggested as effective therapy when the scoop-and-run policy is adopted. In the present study small-volume hypertonic saline treatment and normal saline treatment of “uncontrolled” hemorrhagic shock (UCHS) in rats were compared with no treatment, which best simulates the scoop-and-run policy. The rats were randomly assigned to three groups. Uncontrolled hemorrhagic shock was induced by 12% resection of the terminal portion of the rats' tails. In group I (n = 13) the animals were untreated. In group II (n = 6) UCHS was treated by administering 41.5 mL/kg 0.9% NaCl (NS). In group III (n = 6) UCHS was treated by administering 5 mL/kg 7.5% NaCl (HTS). Resection of the rats' tails in group I was followed by bleeding of 3.3 ± 0.3 mL in 15 minutes with a fall in mean arterial pressure (MAP) from 100.9 ± 7 to 63.5 ± 5 mm Hg (p < 0.001). The early bleeding and hemodynamic responses were similar in all three groups. Further blood loss in the first hour in group I was 0.5 ± 0.2 mL, and MAP rose spontaneously to 73.2 ± 6 mm Hg (p < 0.05). The NS infusion in group II was followed by further bleeding of 4.1 ± 0.9 mL (p < 0.01) and a further fall in MAP to 53.8 ± 7 mm Hg (p < 0.01) after 60 minutes. Small-volume HTS infusion in group III was followed by further bleeding of 6.5 ± 1.0 mL (p < 0.01) and a fall in MAP to 27.6 ± 7 mm Hg (p < 0.005) after 60 minutes. Thirty-one percent of the animals in group I and 33% of the rats in group II died. All animals in group III were dead after 2 hours (p < 0.01). It is concluded that small-volume HTS infusion in uncontrolled hemorrhagic shock led to increased early bleeding, rapid hemodynamic deterioration, and increased mortality. Infusion of normal saline led to increased bleeding and hemodynamic instability but no increased mortality. The animals with no treatment, which best simulates the scoop-and-run policy, were hemodynamically most stable with minimal blood loss.