Whole blood vs saline for MAP restoration in anesthetized piglets after non-traumatic hemorrhagic shock: an experimental study

Abstract

In the management of hemorrhagic shock (HS), the restoration of adequate mean arterial pressure (MAP) while minimizing complications is critical. Whole blood (WB) has demonstrated physiological advantages over crystalloids such as normal saline (NS), yet direct comparisons in non-traumatic HS remain scarce. This study sought to evaluate the volume and hemodynamic efficacy of WB compared to NS in achieving a MAP of 60 mmHg in a porcine model of non-traumatic HS. The WB requirement and the NS volume necessary to restore MAP were 12 [10-14] and 23 [20-24] mL·kg^-1, respectively (p < 0.01). One hour after resuscitation, mean arterial pressure (MAP) in the WB group was 69 [66-73] mmHg, and MAP in the NS group was 57 [55-64] mmHg (p < 0.05). Immediately after resuscitation, a median change of 1.4 [0.8-2.0] mmol·L^-1 and -0.4 [-1.0-0.3] mmol·L^-1 was observed in the WB and NS groups for base excess, respectively (p < 0.05). One hour after resuscitation, lactate levels decreased in median by -3.5 [-4.5 to -2.3] and -1.3 [-2.0 to -0.9] mmol·L^-1 in the WB and NS groups, respectively (p < 0.05). Cardiac output and Syndecan-1 levels did not differ significantly between the groups. In this model of non-traumatic HS, WB showed greater efficacy in restoring MAP with a reduced infusion volume (1:2 WB:NS), exhibiting enhanced markers of metabolic recovery. Despite the comparable endothelial response, as indicated by Syndecan-1 levels, WB yielded more protracted hemodynamic benefits. These findings support the potential use of WB in early HS resuscitation and highlight the need for further investigation in non-trauma HS.

Keywords: Damage control resuscitation; Experimental; Hemorrhagic shock; Whole blood.

Fig. 1

Experimental protocol schema. NS: normal saline, WB: whole blood, MAP: mean arterial pressure.

Fig. 2

Volume of fluid infused to piglets at each resuscitation time. WB: whole blood, NS: normal saline.

Fig. 3

Median difference of base excess, cardiac output, hemoglobin, lactate, arterial CO2 partial pressure, pH and arterial O2 partial pressure between T2 and T3, T2 and T4 and T2 and T3. NS: Normal saline, WB: whole blood, pCO2: arterial CO2 partial pressure, pO2: arterial O2 partial pressure.

Fig. 4

Results of Syndecan-1 levels at baseline (T0), late shock phase (T2), and late resuscitation phase (T4). Syndecan-1 was measured in 16 (100%), 14 (88%), and 14 (88%) piglets at T0, T2, and T4. NS: Normal saline, WB: whole blood.