Effects of extensive bleeding in pigs on laboratory biomarkers
Abstract
Background: During hemorrhage and resuscitation, clinical and laboratory monitoring is useful to guide further management. However, acute changes in the biochemistry due to blood loss and subsequent crystalloid fluid resuscitation have not been fully studied.
Materials and methods: Twelve anesthetized, juvenile pigs were used. Atraumatic exsanguination, corresponding to a total blood loss of 40%, was performed through a catheter and completed 2 h after initiation of the experiment. Arterial samples were analyzed by point-of-care testing and venous samples were analyzed. Oxygen delivery was calculated.
Results: Shortly after 40% hemorrhage and concomitant fluid supplementation, there were significant reductions in arterial hemoglobin and hematocrit (approximately 25%, respectively). Oxygen delivery was less than half of the baseline value. Lactate in arterial blood was more than doubled after 40% exsanguination. On average, no other clinically significant changes in any of the analytes were observed, but interindividual dispersion was pronounced.
Conclusions: Acute exsanguination was associated with decreased hemoglobin and hematocrit levels and increased lactate levels but limited effects on the other biomarkers that were studied. Increased levels of biomarkers in severely bleeding patients could indicate tissue damage and the source should be further investigated.
Downloads
References
- Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care. 2016;20:100. doi: 10.1186/s13054-016-1265-x
- Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23:98. doi: 10.1186/s13054-019-2347-3
- Strandberg G, Larsson A, Lipcsey M, Eriksson M. Comparison of intraosseous, arterial, and venous blood sampling for laboratory analysis in hemorrhagic shock. Clin Lab. 2019;65. doi: 10.7754/Clin.Lab.2019.181214
- Kaptanoglu L, Kurt N, Sikar HE. Current approach to liver traumas. Int J Surg. 2017;39:255–9. doi: 10.1016/j.ijsu.2017.02.015
- Hannon JP, Bossone CA, Wade CE. Normal physiological values for conscious pigs used in biomedical research. Lab Anim Sci. 1990;40:293–8.
- Dunn J-OC, Mythen MG, Grocott MP. Physiology of oxygen transport. BJA Educ. 2016;16:341–8. doi: 10.1093/bjaed/mkw012
- Harrois A, Hamada SR, Duranteau J. Fluid resuscitation and vasopressors in severe trauma patients. Curr Opin Crit Care. 2014;20:632–7. doi: 10.1097/MCC.0000000000000159
- Pearce FJ, Connett RJ, Drucker WR. Extracellular-intracellular lactate gradients in skeletal muscle during hemorrhagic shock in the rat. Surgery. 1985;98:625–31.
- Rashkin MC, Bosken C, Baughman RP. Oxygen delivery in critically ill patients. Relationship to blood lactate and survival. Chest. 1985;87:580–4. doi: 10.1378/chest.87.5.580
- Moore HB, Tessmer MT, Moore EE, Sperry JL, Cohen MJ, Chapman MP, et al. Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock. J Trauma Acute Care Surg. 2020;88:588–96. doi: 10.1097/TA.0000000000002614
- Marques NR, Kramer GC, Voigt RB, Salter MG, Kinsky MP. Trending, accuracy, and precision of noninvasive hemoglobin monitoring during human hemorrhage and fixed crystalloid bolus. Shock. 2015;44:45–9. doi: 10.1097/SHK.0000000000000310
- Semenas E, Nozari A, Wiklund L. Sex differences in cardiac injury after severe haemorrhage and ventricular fibrillation in pigs. Resuscitation. 2010;81:1718–22. doi: 10.1016/j.resuscitation.2010.08.010
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to Upsala Medical Society. Read the full Copyright- and Licensing Statement.
