Influences of Limited Resuscitation with Plasma or Plasma Protein Solutions on Hemostasis and Survival of Rabbits with Non-Compressible Hemorrhage.

Background: Plasma infusion with or without RBC is the current military standard of care for prehospital resuscitation of combat casualties. We examined possible advantages of early and limited resuscitation with fresh plasma compared with a single plasma protein or crystalloid solutions in an uncontrolled hemorrhage model in rabbits. Methods: Anesthetized spontaneously breathing rabbits (3.3+/-0.1 kg) were instrumented and subjected to a splenic uncontrolled hemorrhage. Rabbits in shock were resuscitated at 15 min with Plasma-Lyte (PAL; 30 ml/kg), PAL+ fibrinogen (PAL+F; 30ml+100mg/kg), fresh rabbit plasma (PLS; 15ml/kg), or 25% albumin (ALB; 5 ml/kg) solution; all given in two bolus IV injections (15 min apart) to achieve a MAP of 65 mmHg, n=8-9/group. Animals were monitored for 2 hrs or until death and blood loss was measured. Blood samples and tissues were collected and analyzed. Results: There were no differences among groups in baseline measures and their initial bleeding volume at 15 min. At 60 min post-injury, MAP was higher with albumin than with crystalloids (PAL or PAL+F), but shock indices were not different despite the large differences in resuscitation volumes. Fibrinogen addition to PAL only increased clot strength. Plasma resuscitation increased survival rate (75%) without significant improvement in coagulation measures. Albumin administration replenished total plasma protein, and increased survival rate to 100% (p<.05 vs. crystalloids no histological adverse events were identified in the vital organs. conclusion: fibrinogen administration added to a compatible crystalloid did not improve hemostatic outcomes. plasma resuscitation increased survival rate however its effects differ from those obtained with albumin at of volume. advantage was consistent our previous findings which used volume equal plasma. benefit for may be mostly due content rather than coagulation proteins. lippincott williams wilkins inc.>

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