3.0% NaCl Adenosine, Lidocaine, Mg 2+ (ALM) bolus and 4 hours 'drip' infusion reduces non-compressible hemorrhage by 60% in a rat model.

Background: Noncompressible torso hemorrhage is the leading cause of potentially survivable trauma in far-forward combat environments. Our aim was to examine the effect of small-volume 3% NaCl adenosine, lidocaine and Mg2+ (ALM) bolus and 0.9% NaCl/ALM 'drip' on survivability and cardiac/gut/kidney function in a rat model of hepatic hemorrhage and shock. Methods: Male Sprague-Dawley rats (428+/-4 g) were anesthetized and randomly assigned to one of five groups (n=16): 1) Sham, 2) No Treatment, 3) Saline controls, 4) ALM therapy and 5) Hextend(R). Animals were ventilated, instrumented with single or double laparotomy for tissue probe insertion, and hemorrhage induced by liver resection. After 15 min, a single 3% NaCl +/- ALM bolus (0.7 ml/kg) was injected IV (Phase 1) and after 60 min, 4 hours 0.9% NaCl +/- ALM stabilization 'drip' (0.5 ml/kg/hour) was administered (Phase 2), with 1 hour monitoring. Results: Mortality for Shams (no resection) was 0% (25%); No Treatment, 87.5% (100%); Saline controls, 37.5% (75%); ALM therapy, 0% (25%), and Hextend(R), 87.5% (100%) (double laparotomy in parentheses). Hextend(R)-treated animals died during the first 20 min of Phase 2. A single ALM bolus during Phase 1 led to a 2.4-fold higher cardiac output and improved hemodynamics. 3% NaCl ALM bolus increased tissue pO2 and flow in gut and kidney during Phase 1 and, during ALM 'drip' in Phase 2, tissue pO2 decreased but flow continued to rise, indicating increased tissue O2 extraction and delivery. During Phase 2, CO, ejection fraction and fractional shortening decreased and were erratic in all groups except ALM-treatment. ALM therapy led to up to 60% less bleeding over 6 hours compared to Saline controls, and 75% less bleeding than Hextend(R). Conclusions: Small-volume ALM therapy significantly reduced mortality and internal bleeding compared to Saline controls or Hextend(R)-treated rats. Hextend(R) increased mortality, severe bleeding and microvascular-organ injury. (C) 2017 Lippincott Williams & Wilkins, Inc.

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