Resuscitation from Hemorrhagic Shock after Traumatic Brain Injury with Polymerized Hemoglobin
Authors: Muller Cynthia R. , Lucas Alfredo , Courelli Vasiliki , Dos Santos Fernando , Cuddington Clayton , Moses Savannah , Palmer Andre F. , Kistler Erik , Cabrales Pedro 
Published: April 2020

Hemorrhagic Shock (HS) after Traumatic Brain Injury (TBI) is common and lethal among military and civilians. Blood transfusion has been the resuscitation gold standard procedure for many years. However, only 3% of age‐eligible individuals donate blood, which limits blood availability and cannot meet current blood demands. This study was compared the efficacy to resuscitate from HS after TBI via infusion of Lactated Ringer’s solution (LR, electrolyte solution used to restore the loss of blood volume), fresh blood (Blood, autologous blood drawn during the hemorrhage), or Polymerized Hemoglobin [PolyHb, a Hemoglobin Based Oxygen Carrier (HBOC) that shows promise in increasing oxygenation]. Fifteen Wistar rats (350–400g) were instrumented with catheters in the femoral artery and vein and subjected to TBI through a pneumatic controlled cortical impact (CCI) (Leica Biosystems, Vista, CA). To induce TBI, a 5mm craniotomy over the right cerebral cortex was performed, and the scalp was impacted at a velocity of 5m/s and dwell time of 200ms. The scalp was subsequently closed and animals were given 10 min to stabilize before performing HS. HS was induced by blood withdrawal from the femoral artery catheter to achieve a mean arterial pressure (MAP) between 35–40mmHg, and the hypotensive state was maintained for 90 min before resuscitation. Animals were separated into 3 groups based on the resuscitation solution: Blood, LR, or PolyHb. Animals were monitored for an additional 120 min before euthanasia. Measurements were taken at baseline (BL), 90 min into HS (HS), and 30 min (R1) and 2 hours (R2) after resuscitation. The MAP, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were decreased equally in all groups during HS. Blood and PolyHb groups increased MAP compared to the LR group at R1. The MAP was not different between Blood and PolyHb at R2. The SBP was increased only for the Blood group as compared to the LR group at R1. Moreover, DBP was increased for both Blood and PolyHb compared to the LR group at R1 and R2. As expected, hematocrit decreased in all groups after HS, with only the Blood group recovering hematocrit after resuscitation. Total hemoglobin (tHb) decreased after HS, and increased after resuscitation for the Blood and PolyHb groups but not in the LR group. Oxygen saturation was decreased for the Blood and PolyHb groups compared to the LR group at R1 and R2. The oxygen saturation was increased on the Blood group compared to PolyHb group at R2. After HS all groups increased lactate, after R1 just Blood and LR group recovered lactate to BL levels, and PolyHb did not decreased lactate concentration at R2 compared to the blood group. In conclusion, our results show that PolyHb was effective to resuscitation from HS after TBI, restoring blood pressure similarly to Blood group and could be a good alternative to transfusion for field resuscitation from HS after TBI.Support or Funding InformationThis work was supported by the NIH Heart Lung and Blood Institute under Grant, R01‐HL126945, and the DOD DMRDP under Grants W81XWH‐18‐1‐0059, W81XWH‐17‐2‐0047