Comparison of the hemostatic efficacy of low-volume lyophilized plasma reconstituted using sterile water, lactated Ringer's, normal saline, and Hextend solutions

Tim H. Lee, Sean P. McCully, Belinda McCully, Claire Sands, David A. Hampton, Scott G. Louis, Beth Rick, Nathan Anderson, Jerome Differding, Martin Schreiber

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Low-volume ascorbic acid-buffered reconstituted lyophilized plasma (LP) provides logistic advantages, reduces the risks for large-volume resuscitation, modulates inflammation, and is equally effective for hemostatic resuscitation as full-volume LP. We compared the physiologic effects of resuscitation using LP reconstituted with sterile water (LP-SW), lactated Ringer's solution (LP-LR), normal saline (LP-NS), and Hextend (LP-Hx). METHODS: Plasma was collected from swine, lyophilized, and then reconstituted into four test solutions: LP-SW, LP-LR, LP-NS, or LP-Hx. Forty swine were anesthetized and subjected to a validated model of polytrauma and hemorrhagic shock (including a Grade V liver injury), then randomized to receive one of the four test solutions. Physiologic parameters, blood loss, lactate, and hematocrit were followed up. Coagulation status was evaluated using thrombelastography. Inflammatory mediator expression was evaluated by multiplex serum assay. RESULTS: Forty animals were included in the study (10 animals per group). One animal died following LP-Hx resuscitation. There was less blood loss in the LP-SW and LP-LR groups compared with the LP-NS and LP-Hx groups (p <0.05). The LP-SW group exhibited less early coagulopathic changes by thrombelastography, and the LP-Hx group had persistently elevated international normalized ratios at the end of the study period (p <0.05). Serum interleukin 6 was lower after 4 hours in the LP-SW group compared with LP-NS (p <0.05). CONCLUSION: Resuscitation using low-volume LP-SW and LP-LR buffered with ascorbic acid confers an anti-inflammatory benefit and results in less blood loss. Sterile water is a safe, cost-effective, and universally available fluid for creating a low-volume hemostatic LP resuscitation solution.

Original languageEnglish (US)
Pages (from-to)264-272
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Plasma Volume
Hemostatics
Sodium Chloride
Water
Resuscitation
Ringer's lactate
Thrombelastography
Ascorbic Acid
Swine
International Normalized Ratio
Hemorrhagic Shock
Multiple Trauma

Keywords

  • coagulopathy
  • Hemostatic resuscitation
  • lyophilized plasma
  • swine

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Comparison of the hemostatic efficacy of low-volume lyophilized plasma reconstituted using sterile water, lactated Ringer's, normal saline, and Hextend solutions. / Lee, Tim H.; McCully, Sean P.; McCully, Belinda; Sands, Claire; Hampton, David A.; Louis, Scott G.; Rick, Beth; Anderson, Nathan; Differding, Jerome; Schreiber, Martin.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 2, 02.2014, p. 264-272.

Research output: Contribution to journalArticle

Lee, Tim H. ; McCully, Sean P. ; McCully, Belinda ; Sands, Claire ; Hampton, David A. ; Louis, Scott G. ; Rick, Beth ; Anderson, Nathan ; Differding, Jerome ; Schreiber, Martin. / Comparison of the hemostatic efficacy of low-volume lyophilized plasma reconstituted using sterile water, lactated Ringer's, normal saline, and Hextend solutions. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 2. pp. 264-272.
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AU - Lee, Tim H.

AU - McCully, Sean P.

AU - McCully, Belinda

AU - Sands, Claire

AU - Hampton, David A.

AU - Louis, Scott G.

AU - Rick, Beth

AU - Anderson, Nathan

AU - Differding, Jerome

AU - Schreiber, Martin

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N2 - BACKGROUND: Low-volume ascorbic acid-buffered reconstituted lyophilized plasma (LP) provides logistic advantages, reduces the risks for large-volume resuscitation, modulates inflammation, and is equally effective for hemostatic resuscitation as full-volume LP. We compared the physiologic effects of resuscitation using LP reconstituted with sterile water (LP-SW), lactated Ringer's solution (LP-LR), normal saline (LP-NS), and Hextend (LP-Hx). METHODS: Plasma was collected from swine, lyophilized, and then reconstituted into four test solutions: LP-SW, LP-LR, LP-NS, or LP-Hx. Forty swine were anesthetized and subjected to a validated model of polytrauma and hemorrhagic shock (including a Grade V liver injury), then randomized to receive one of the four test solutions. Physiologic parameters, blood loss, lactate, and hematocrit were followed up. Coagulation status was evaluated using thrombelastography. Inflammatory mediator expression was evaluated by multiplex serum assay. RESULTS: Forty animals were included in the study (10 animals per group). One animal died following LP-Hx resuscitation. There was less blood loss in the LP-SW and LP-LR groups compared with the LP-NS and LP-Hx groups (p <0.05). The LP-SW group exhibited less early coagulopathic changes by thrombelastography, and the LP-Hx group had persistently elevated international normalized ratios at the end of the study period (p <0.05). Serum interleukin 6 was lower after 4 hours in the LP-SW group compared with LP-NS (p <0.05). CONCLUSION: Resuscitation using low-volume LP-SW and LP-LR buffered with ascorbic acid confers an anti-inflammatory benefit and results in less blood loss. Sterile water is a safe, cost-effective, and universally available fluid for creating a low-volume hemostatic LP resuscitation solution.

AB - BACKGROUND: Low-volume ascorbic acid-buffered reconstituted lyophilized plasma (LP) provides logistic advantages, reduces the risks for large-volume resuscitation, modulates inflammation, and is equally effective for hemostatic resuscitation as full-volume LP. We compared the physiologic effects of resuscitation using LP reconstituted with sterile water (LP-SW), lactated Ringer's solution (LP-LR), normal saline (LP-NS), and Hextend (LP-Hx). METHODS: Plasma was collected from swine, lyophilized, and then reconstituted into four test solutions: LP-SW, LP-LR, LP-NS, or LP-Hx. Forty swine were anesthetized and subjected to a validated model of polytrauma and hemorrhagic shock (including a Grade V liver injury), then randomized to receive one of the four test solutions. Physiologic parameters, blood loss, lactate, and hematocrit were followed up. Coagulation status was evaluated using thrombelastography. Inflammatory mediator expression was evaluated by multiplex serum assay. RESULTS: Forty animals were included in the study (10 animals per group). One animal died following LP-Hx resuscitation. There was less blood loss in the LP-SW and LP-LR groups compared with the LP-NS and LP-Hx groups (p <0.05). The LP-SW group exhibited less early coagulopathic changes by thrombelastography, and the LP-Hx group had persistently elevated international normalized ratios at the end of the study period (p <0.05). Serum interleukin 6 was lower after 4 hours in the LP-SW group compared with LP-NS (p <0.05). CONCLUSION: Resuscitation using low-volume LP-SW and LP-LR buffered with ascorbic acid confers an anti-inflammatory benefit and results in less blood loss. Sterile water is a safe, cost-effective, and universally available fluid for creating a low-volume hemostatic LP resuscitation solution.

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KW - Hemostatic resuscitation

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KW - swine

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