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Selective aortic arch perfusion with fresh whole blood or HBOC-201 reverses hemorrhage-induced traumatic cardiac arrest in a lethal model of noncompressible torso hemorrhage

Hoops, Heather E. MD; Manning, James E. MD; Graham, Todd L. BS; McCully, Belinda H. PhD; McCurdy, Shane L. BS; Ross, James D. PhD

Journal of Trauma and Acute Care Surgery: August 2019 - Volume 87 - Issue 2 - p 263–273
doi: 10.1097/TA.0000000000002315
AAST 2018 PODIUM
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BACKGROUND Hemorrhage-induced traumatic cardiac arrest (HiTCA) has a dismal survival rate. Previous studies demonstrated selective aortic arch perfusion (SAAP) with fresh whole blood (FWB) improved the rate of return of spontaneous circulation (ROSC) after HiTCA, compared with resuscitative endovascular balloon occlusion of the aorta and cardiopulmonary resuscitation (CPR). Hemoglobin-based oxygen carriers, such as hemoglobin-based oxygen carrier (HBOC)-201, may alleviate the logistical constraints of using FWB in a prehospital setting. It is unknown whether SAAP with HBOC-201 is equivalent in efficacy to FWB, whether conversion from SAAP to extracorporeal life support (ECLS) is feasible, and whether physiologic derangement post-SAAP therapy is reversible.

METHODS Twenty-six swine (79 ± 4 kg) were anesthetized and underwent HiTCA which was induced via liver injury and controlled hemorrhage. Following arrest, swine were randomly allocated to resuscitation using SAAP with FWB (n = 12) or HBOC-201 (n = 14). After SAAP was initiated, animals were monitored for a 20-minute prehospital period prior to a 40-minute damage control surgery and resuscitation phase, followed by 260 minutes of critical care. Primary outcomes included rate of ROSC, survival, conversion to ECLS, and correction of physiology.

RESULTS Baseline physiologic measurements were similar between groups. ROSC was achieved in 100% of the FWB animals and 86% of the HBOC-201 animals (p = 0.483). Survival (t = 320 minutes) was 92% (11/12) in the FWB group and 67% (8/12) in the HBOC-201 group (p = 0.120). Conversion to ECLS was successful in 100% of both groups. Lactate peaked at 80 minutes in both groups, and significantly improved by the end of the experiment in the HBOC-201 group (p = 0.001) but not in the FWB group (p = 0.104). There was no significant difference in peak or end lactate between groups.

CONCLUSION Selective aortic arch perfusion is effective in eliciting ROSC after HiTCA in a swine model, using either FWB or HBOC-201. Transition from SAAP to ECLS after definitive hemorrhage control is feasible, resulting in high overall survival and improvement in lactic acidosis over the study period.

From the Department of Surgery (H.E.H.), Oregon Health and Science University, Portland, Oregon; Department of Emergency Medicine (J.E.M., S.L.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Division of Trauma, Critical Care and Acute Care Surgery (T.L.G., B.H.M., J.D.R.), Oregon Health and Science University, Portland, Oregon.

Submitted: August 1, 2018, Revised: February 27, 2019, Accepted: March 16, 2019, Published online: April 18, 2019.

Presented at the 77th Annual Meeting at American Association for the Surgery of Trauma, September 26–29, 2018, in San Diego, CA.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: James D. Ross, PhD, Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Rd, Portland, OR 97239; email: rosja@ohsu.edu.

Online date: April 24, 2019

© 2019 Lippincott Williams & Wilkins, Inc.