Resuscitation of traumatic brain injury and hemorrhagic shock with polynitroxylated albumin, hextend, hypertonic saline, and lactated Ringer's: Effects on acute hemodynamics, survival, and neuronal death in mice

• Published in: Journal of neurotrauma Vol. 26; no. 12; p. 2403
• Main Authors: Exo, Jennifer L, Shellington, David K, Bayir, Hülya, Vagni, Vincent A, Janesco-Feldman, Keri, Ma, Lil, Hsia, Carleton J, Clark, Robert S B, Jenkins, Larry W, Dixon, C Edward, Kochanek, Patrick M
• Format: Journal Article
• Language: English
• Published: United States 01-12-2009
• Subjects: Albumins - pharmacology; Albumins - therapeutic use; Animals; Blood Volume - drug effects; Blood Volume - physiology; Brain - drug effects; Brain - pathology; Brain - physiopathology; Brain Injuries - drug therapy; Brain Injuries - physiopathology; Cell Count; Disease Models, Animal; Emergency Medical Services - methods; Hemodynamics - drug effects; Hemodynamics - physiology; Hippocampus - drug effects; Hippocampus - pathology; Hippocampus - physiopathology; Hydroxyethyl Starch Derivatives - pharmacology; Hydroxyethyl Starch Derivatives - therapeutic use; Hypotension - drug therapy; Hypotension - physiopathology; Isotonic Solutions - pharmacology; Isotonic Solutions - therapeutic use; Male; Mice; Mice, Inbred C57BL; Nerve Degeneration - drug therapy; Nerve Degeneration - physiopathology; Nerve Degeneration - prevention & control; Oxidative Stress - drug effects; Oxidative Stress - physiology; Resuscitation - methods; Ringer's Lactate; Saline Solution, Hypertonic - pharmacology; Saline Solution, Hypertonic - therapeutic use; Shock, Hemorrhagic - drug therapy; Shock, Hemorrhagic - etiology; Shock, Hemorrhagic - physiopathology; Survival Rate; Treatment Outcome
• DOI: 10.1089/neu.2009.0980
• EISSN: 1557-9042

Outcome after traumatic brain injury (TBI) is worsened by hemorrhagic shock (HS), but the optimal resuscitation approach is unclear. In particular, treatment of TBI patients with colloids remains controversial. We hypothesized that resuscitation with the colloids polynitroxylated albumin (PNA) or Hextend (HEX) is equal or superior to resuscitation with the crystalloids hypertonic (3%) saline (HTS) or lactated Ringer's solution (LR) after TBI plus HS in mice. C57/BL6 mice (n = 30) underwent controlled cortical impact (CCI) and 90 min of volume-controlled HS (2 mL/100 g). The mice were randomized to resuscitation with LR, HEX, HTS, or PNA, followed by 30 min of test fluid administration targeting a mean arterial pressure (MAP) of >50 mm Hg. Shed blood was re-infused to target a MAP >70 mm Hg. At 7 days post-insult, hippocampal neuron counts were assessed in hematoxylin and eosin-stained sections to quantify neuronal damage. Prehospital MAP was higher, and prehospital and total fluid requirements were lower in the PNA and HEX groups (p < 0.05 versus HTS or LR). Also, 7-day survival was highest in the PNA group, but was not significantly different than the other groups. Ipsilateral hippocampal CA1 and CA3 neuron loss did not differ between groups. We conclude that the colloids PNA and HEX exhibited more favorable effects on acute resuscitation parameters than HTS or LR, and did not increase hippocampal neuronal death in this model.