Low Volume Resuscitation Using Polyethylene Glycol-20k in a Pre-Clinical Porcine Model of Hemorrhagic Shock.

Introduction: Polyethylene glycol-20k (PEG-20k) is highly effective for low volume resuscitation (LVR) by increasing tolerance to the low volume state. In our rodent shock model, PEG-20k increased survival and expanded the "golden hour" 16-fold compared to saline. The molecular mechanism is largely attributed to normalizations in cell and tissue fluid shifts after low flow ischemia resulting in efficient microvascular exchange. The objective of this study was to evaluate PEG-20k as a low volume resuscitation solution for hemorrhagic shock in a pre-clinical model. Methods: Anesthetized male Yorkshire pigs (30-40 kg) were hemorrhaged to a MAP of 35-40 mmHg. Once lactate reached 7 mM/L, either saline (n = 5) or 10% PEG-20k (n = 5) was rapidly infused at 10% calculated blood volume. The primary outcome was LVR time, defined by the time from LVR administration to the time when lactate again reached 7 mM/L. Other outcomes measured included: MAP, heart rate (HR), cardiac output (CO), mixed venous oxygen saturation (SvO2), splanchnic blood flow, and hemoglobin. Results: Relative to saline, PEG-20k given after controlled hemorrhage increased LVR time by 16-fold, a conservative estimate given that the lactate never rose after LVR in the PEG-20k group. Survival was 80% for PEG-20k LVR compared to 0% for the saline controls (P

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