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For: Jammula S, Miller JA, Morrison CA. Rapid Release Protocol Optimizes Product Utilization Compared With Massive Transfusion Protocol in Selected Patients. J Surg Res 2018;232:553-558. [PMID: 30463772 DOI: 10.1016/j.jss.2018.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/30/2018] [Accepted: 07/13/2018] [Indexed: 01/25/2023]

For:	Jammula S, Miller JA, Morrison CA. Rapid Release Protocol Optimizes Product Utilization Compared With Massive Transfusion Protocol in Selected Patients. J Surg Res 2018;232:553-558. [PMID: 30463772 DOI: 10.1016/j.jss.2018.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/30/2018] [Accepted: 07/13/2018] [Indexed: 01/25/2023]

Number	Cited by Other Article(s)
1	Zusman BE, Kochanek PM, Bailey ZS, Leung LY, Vagni VA, Okonkwo DO, Puccio AM, Shutter LA, Janesko-Feldman KL, Gilsdorf JS, Shear DA, Jha RM. Multifaceted Benefit of Whole Blood Versus Lactated Ringer's Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice. Neurocrit Care 2021;34:781-94. [PMID: 32886294 DOI: 10.1007/s12028-020-01084-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022] Abstract BACKGROUND Despite increasing use in hemorrhagic shock (HS), whole blood (WB) resuscitation for polytrauma with traumatic brain injury (TBI) is largely unexplored. Current TBI guidelines recommend crystalloid for prehospital resuscitation. Although WB outperforms lactated Ringer's (LR) in increasing mean arterial pressure (MAP) in TBI + HS models, effects on brain tissue oxygenation (PbtO₂), and optimal MAP remain undefined. METHODS C57BL/6 mice (n = 72) underwent controlled cortical impact followed by HS (MAP = 25-27 mmHg). Ipsilateral hippocampal PbtO₂ (n = 40) was measured by microelectrode. Mice were assigned to four groups (n = 18/group) for "prehospital" resuscitation (90 min) with LR or autologous WB, and target MAPs of 60 or 70 mmHg (LR₆₀, WB₆₀, LR₇₀, WB₇₀). Additional LR (10 ml/kg) was bolused every 5 min for MAP below target. RESULTS LR requirements in WB₆₀ (7.2 ± 5.0 mL/kg) and WB₇₀ (28.3 ± 9.6 mL/kg) were markedly lower than in LR₆₀ (132.8 ± 5.8 mL/kg) or LR₇₀ (152.2 ± 4.8 mL/kg; all p < 0.001). WB₇₀ MAP (72.5 ± 2.9 mmHg) was higher than LR₇₀ (59.8 ± 4.0 mmHg, p < 0.001). WB₆₀ MAP (68.7 ± 4.6 mmHg) was higher than LR₆₀ (53.5 ± 3.2 mmHg, p < 0.001). PbtO₂ was higher in WB₆₀ (43.8 ± 11.6 mmHg) vs either LR₆₀ (25.9 ± 13.0 mmHg, p = 0.04) or LR₇₀ (24.1 ± 8.1 mmHg, p = 0.001). PbtO₂ in WB₇₀ (40.7 ± 8.8 mmHg) was higher than in LR₇₀ (p = 0.007). Despite higher MAP in WB₇₀ vs WB₆₀ (p = .002), PbtO₂ was similar. CONCLUSION WB resuscitation after TBI + HS results in robust improvements in brain oxygenation while minimizing fluid volume when compared to standard LR resuscitation. WB resuscitation may allow for a lower prehospital MAP without compromising brain oxygenation when compared to LR resuscitation. Further studies evaluating the effects of these physiologic benefits on outcome after TBI with HS are warranted, to eventually inform clinical trials. Collapse Key Words Brain injuries Hemorrhagic Multiple trauma Resuscitation Shock Traumatic Collapse MESH Headings Collapse Grants Collapse Affiliation(s) Collapse

Number

Cited by Other Article(s)

Zusman BE, Kochanek PM, Bailey ZS, Leung LY, Vagni VA, Okonkwo DO, Puccio AM, Shutter LA, Janesko-Feldman KL, Gilsdorf JS, Shear DA, Jha RM. Multifaceted Benefit of Whole Blood Versus Lactated Ringer's Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice. Neurocrit Care 2021;34:781-94. [PMID: 32886294 DOI: 10.1007/s12028-020-01084-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]

Abstract

BACKGROUND

Despite increasing use in hemorrhagic shock (HS), whole blood (WB) resuscitation for polytrauma with traumatic brain injury (TBI) is largely unexplored. Current TBI guidelines recommend crystalloid for prehospital resuscitation. Although WB outperforms lactated Ringer's (LR) in increasing mean arterial pressure (MAP) in TBI + HS models, effects on brain tissue oxygenation (PbtO₂), and optimal MAP remain undefined.

METHODS

C57BL/6 mice (n = 72) underwent controlled cortical impact followed by HS (MAP = 25-27 mmHg). Ipsilateral hippocampal PbtO₂ (n = 40) was measured by microelectrode. Mice were assigned to four groups (n = 18/group) for "prehospital" resuscitation (90 min) with LR or autologous WB, and target MAPs of 60 or 70 mmHg (LR₆₀, WB₆₀, LR₇₀, WB₇₀). Additional LR (10 ml/kg) was bolused every 5 min for MAP below target.

RESULTS

LR requirements in WB₆₀ (7.2 ± 5.0 mL/kg) and WB₇₀ (28.3 ± 9.6 mL/kg) were markedly lower than in LR₆₀ (132.8 ± 5.8 mL/kg) or LR₇₀ (152.2 ± 4.8 mL/kg; all p < 0.001). WB₇₀ MAP (72.5 ± 2.9 mmHg) was higher than LR₇₀ (59.8 ± 4.0 mmHg, p < 0.001). WB₆₀ MAP (68.7 ± 4.6 mmHg) was higher than LR₆₀ (53.5 ± 3.2 mmHg, p < 0.001). PbtO₂ was higher in WB₆₀ (43.8 ± 11.6 mmHg) vs either LR₆₀ (25.9 ± 13.0 mmHg, p = 0.04) or LR₇₀ (24.1 ± 8.1 mmHg, p = 0.001). PbtO₂ in WB₇₀ (40.7 ± 8.8 mmHg) was higher than in LR₇₀ (p = 0.007). Despite higher MAP in WB₇₀ vs WB₆₀ (p = .002), PbtO₂ was similar.

CONCLUSION

WB resuscitation after TBI + HS results in robust improvements in brain oxygenation while minimizing fluid volume when compared to standard LR resuscitation. WB resuscitation may allow for a lower prehospital MAP without compromising brain oxygenation when compared to LR resuscitation. Further studies evaluating the effects of these physiologic benefits on outcome after TBI with HS are warranted, to eventually inform clinical trials.

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