Elsevier

Resuscitation

Volume 29, Issue 2, April 1995, Pages 143-152
Resuscitation

Experimental paper
Uncontrolled hemorrhagic shock outcome model in rats

https://doi.org/10.1016/0300-9572(95)00829-IGet rights and content

Abstract

During uncontrolled hemorrhagic shock (UHS) in acute animal models, attempts to achieve normotension with i.v. fluid resuscitation (FR) caused further bleeding and higher acute mortality. In the absence of a published clinically realistic long-term animal outcome study of UHS, we developed such a model in rats. In the preliminary study, phase I of the model involved 60 min of simulated ‘pre-hospital’ UHS by tail amputation and different FR regimens. Phase II involved 120 min of simulated ‘hospital’ treatment with hemostasis and all-out FR, including blood infusion. Phase III involved observing recovery and survival to 72 h (3 days). Rats were maintained under very light N2O-O2-halothane anesthesia and spontaneous breathing via mask during phases I and II and were awake during phase III. Tail amputation-induced UHS alone, studied in 4 groups of 10 rats each, resulted in unpredictable spontaneous hemostasis and great variability in shed blood volume, severity of shock, and mortality. The final model, which achieved consistent blood loss and outcome, included an initial volume-controlled hemorrhage of 3 ml/100 g over 15 min and untreated HS for another 15 min, followed by tail amputation for UHS over another 60 min. This phase I of 90 min was followed by phase II of 60 min. In group 1, without FR in phases I and II, all 10 rats died by 12 h. In group 2, without FR in phase I and hemostasis plus all-out FR with lactated Ringer's solution and blood to hematocrit (Hct) 30% in phase II, 5 of 10 rats died at the end of phase I and 9 of 10 died at the end of phase III. This final volume-initiated UHS model may be suitable for comparing different pre-hospital treatment modalities in terms of outcome.

References (38)

  • CJ Wiggers

    Physiology of shock

  • GT Shires et al.

    Fluid therapy in hemorrhagic shock

    Arch Surg

    (1964)
  • LW Traverso et al.

    Fluid resuscitation after an otherwise fatal hemorrhage. I. Crystalloid solutions

    J Trauma

    (1986)
  • WH Bickell et al.

    Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries

    N Engl J Med

    (1994)
  • E Gross et al.

    Is hypertonic saline resuscitation safe in ‘uncontrolled’ hemorrhagic shock?

    J Trauma

    (1988)
  • WH Bickell et al.

    The detrimental effects of intravenous crystalloid after aortotomy in swine

    Surgery

    (1991)
  • T Kowalenko et al.

    Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model

    J Trauma

    (1992)
  • MM Krausz et al.

    ‘Scoop and run’ or stabilize hemorrhagic shock with normal saline or small-volume hypertonic saline?

    J Trauma

    (1992)
  • A Capone et al.

    Uncontrolled hemorrhagic shock outcome model in rats (abstract)

    Ann Emerg Med

    (1993)
  • Cited by (80)

    • Association of hemodilution and blood pressure in uncontrolled bleeding

      2013, Journal of Surgical Research
      Citation Excerpt :

      For instance, when there is a 40% reduction of three coagulation factor concentrations, there is an 80% reduction in their activity, ultimately producing a >90% decrease in overall activity of the coagulation system [7]. This phenomenon is of concern because with a reduction in hemostatic capacity during initial treatment from fluid replacement, hemorrhage is induced and mortality increases [9,14–17]. Hemodilution by aggressive fluid resuscitation not only causes hemostatic capacity to be reduced but resuscitation may have detrimental effects on hemodynamics [9,17,18].

    • Walking between the drops: Israeli defense forces' fluid resuscitation protocol

      2013, Journal of Emergency Medicine
      Citation Excerpt :

      The final version was approved and disseminated in September 2010. Due to the dearth of human trials, we started by reviewing literature from animal studies, including swine, rat, and sheep models (2–13). Results of most of these studies followed a consistent pattern: limited-volume fluid resuscitation achieved the best results, high-volume fluid resuscitation was less good, and no-fluid resuscitation was worst.

    • Haemostatic resuscitation

      2012, British Journal of Anaesthesia
      Citation Excerpt :

      The distinction between controlled haemorrhage, as in the classic Wiggers model, and uncontrolled haemorrhage was first explored in animal models in the 1990s. Results from multiple resuscitation trials in pigs,24 23 rats,25 dogs,26 and sheep27 demonstrated that blood loss was reduced during hypotension. Survival was improved with resuscitation strategies that limited the amount of fluid administered or titrated it to a lower than normal mean arterial pressure.

    • Trauma and Acute Care

      2012, Anesthesia and Uncommon Diseases: Sixth Edition
    • What Is the Best Approach to Fluid Management, Transfusion Therapy, and the End Points of Resuscitation in Trauma?

      2010, Evidence-Based Practice of Critical Care: Expert Consult: Online and Print
    View all citing articles on Scopus
    View full text