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CARDIOVASCULAR ANESTHESIOLOGY

Less Impairment of Hemostasis and Reduced Blood Loss in Pigs After Resuscitation from Hemorrhagic Shock Using the Small-Volume Concept with Hypertonic Saline/Hydroxyethyl Starch as Compared to Administration of 4% Gelatin or 6% Hydroxyethyl Starch Solution

Thorsten Haas, MD^*, Dietmar Fries, MD, Carmen Holz, MD^*, Petra Innerhofer, MD^*, Werner Streif, MD, Anton Klingler, PhD, Alexander Hanke, MD^||, and Corinna Velik-Salchner, MD^*

From the Departments of *Anaesthesiology and Critical Care Medicine, General and Surgical Critical Care Medicine, Pediatrics, Innsbruck Medical University, Department of General and Transplant Surgery, Division of Theoretical Surgery, Innsbruck Medical University, Innsbruck, Austria; and ||Department of Anaesthesiology and Intensive Care Medicine, University Clinics of Essen, Essen, Germany.

Address correspondence and reprint requests to Thorsten Haas, MD, Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to thorsten.haas{at}i-med.ac.at.

Abstract

BACKGROUND: Small-volume resuscitation using hypertonic saline/hydroxyethyl starch 200/0.62 (HS-HES) has been shown to be an effective alternative to the administration of crystalloids or colloids in trauma patients. All IV fluids cause dose-related dilutional coagulopathy and show intrinsic effects on the hemostatic system, but only few data refer to functional consequences after small-volume resuscitation.

METHODS: Using thrombelastometry (ROTEM®), we studied 30 pigs (weighing 35–45 kg) after withdrawal of 60% of blood volume [1484 mL (1369–1624 mL)] and receiving 4 mL/kg HS-HES for compensation of blood loss or 4% gelatin or 6% HES 130/0.4 in a 1:1 ratio to lost blood volume. To compare the ROTEM variables (coagulation time, clot formation time, angle, clot firmness, and fibrinogen polymerization) with bleeding tendency, a hepatic incision was made and blood loss was measured.

RESULTS: Median (25th, 75th percentile) fibrinogen polymerization was significantly higher after HS-HES infusion [11 mm (10, 11), P = 0.0034] when compared with administration of 4% gelatin [4.5 mm (3.0, 5.8)] or HES 130/0.4 [3.5 mm (2.3, 4.0)]. Median blood loss after liver incision was 725 mL (900, 375) after HS-HES, 1625 mL (1275, 1950) after 4% gelatin, and 1600 mL (1500, 1800) after 6% HES 130/0.4 (P = 0.004). Hemodynamic stabilization was traceable in all groups but showed differences regarding filling pressures.

CONCLUSIONS: Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin.