Small-volume infusion of 7.5% NaCl in 6% Dextran 70 for the treatment of severe hemorrhagic shock in swine

Abstract

In the initial treatment of the hypovolemic trauma patient, commonly used crystalloids have little clinical benefit in the small volumes generally infused during transport. We evaluated the efficacy of a small-volume infusion of 7.5% NaCl in 6% Dextran 70 as a treatment modality for an otherwise lethal hemorrhage in swine. Sixty chronically instrumented swine were randomized into one of four treatment groups: 0.9% NaCl (NS, n = 15), 7.5% NaCl (HS, n = 15), 6% Dextran 70 (DEX, n = 16), and 7.5% NaCl in 6% Dextran 70 (HSD, n = 14). Each animal was bled 46 mL/kg in 15 minutes. Five minutes after the completion of hemorrhage, the animals were infused with their respective treatment in a volume (11.5 mL/kg) equal to 25% of the shed blood. Of those animals receiving HSD, 100% survived until euthanized at 96 hours. In comparison, animals infused with NS, HS, and DEX had 96-hour survival values of 13%, 53%, and 69%, respectively. The survival rate of the HSD group was significantly better than that of the NS group (P less than .001) and the HS group (P less than .01). The infusion of HSD increased mean arterial pressure, PCO2, and plasma bicarbonate to a significantly greater extent than NS alone (P less than .05). These results demonstrate that a small-volume infusion of the hypertonic sodium chloride/dextran solution is superior to equal volumes of a standard crystalloid in resuscitating animals from hemorrhagic shock.