Does small-volume resuscitation with crystalloids or colloids influence hemostasis and survival of rabbits subjected to lethal uncontrolled hemorrhage?.

Introduction: Prehospital, small-volume resuscitation of combat casualties with a synthetic colloid [6% hydroxyethyl starch (HES) 670/0.75] has been recommended when blood or blood components are unavailable. We studied hemostatic effects of a newer synthetic colloid (6% HES 130/0.4,) compared to either a natural colloid (albumin) or to crystalloids in an uncontrolled hemorrhage model. Methods: Spontaneously breathing NZW rabbits (3.4+/-0.1 kg) were anesthetized, instrumented and subjected to a splenic injury with uncontrolled bleeding. Fifteen minutes after injury, rabbits were in shock (MAP= 26 +/-1.3 mmHg, and received colloids (6% HES 130/0.4 or 5% albumin at 15mL/kg), or crystalloids (normal saline at 30 mL/kg or 5% hypertonic saline at 7.5 mL/kg) for resuscitation in two intravenous bolus injections (15 minutes apart) to raise their MAP to 65 mm Hg, n=9/group. Animals were monitored for 2.5 hrs or until death, and blood losses were measured. Blood samples were analyzed for ABG, CBC, and coagulation measures. Results: There were no differences among groups in baseline measures and initial hemorrhage volume (11.9+/-0.6 mL/kg) at 15 minutes post-injury. Twenty minutes after fluid resuscitation (1hr post-injury), MAP was higher, shock indices were lower and blood pH was higher in colloids vs. crystalloids groups (p

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