Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model

Laszlo N. Kiraly, Jerome A. Differding, T. Miko Enomoto, Rebecca S. Sawai, Patrick J. Muller, Brian Diggs, Brandon Tieu, Michael S. Englehart, Samantha Underwood, Tracy T. Wiesberg, Martin Schreiber

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Lactated ringers (LR) and normal saline (NS) are used interchangeably in many trauma centers. The purpose of this study was to compare the effects of LR and NS on coagulation in an uncontrolled hemorrhagic swine model. We hypothesized resuscitation with LR would produce hypercoagulability. METHODS: There were 20 anesthetized swine (35 ± 3 kg) that underwent central venous and arterial catheterization, celiotomy, and splenectomy. After splenectomy blinded study fluid equal to 3 mL per gram of splenic weight was administered. A grade V liver injury was made and animals bled without resuscitation for 30 minutes. Animals were resuscitated with the respective study fluid to, and maintained, at the preinjury MAP until study end. Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and fibrinogen were collected at baseline (0′) and study end (120′). Thrombelastography was performed at 0′and postinjury at 30′, 60′, 90′, and 120′. RESULTS: There were no significant baseline group differences in R value, PT, PTT, and fibrinogen. There was no significant difference between baseline and 30 minutes R value with NS (p = 0.17). There was a significant R value reduction from baseline to 30 minutes with LR (p = 0.02). At 60 minutes, R value (p = 0.002) was shorter while alpha angle, maximum amplitude, and clotting index were higher (p <0.05) in the LR versus the NS group. R value, PT, and PTT were significantly decreased at study end in the LR group compared with the NS group (p <0.05). Overall blood loss was significantly higher in the NS versus LR group (p = 0.009). CONCLUSIONS: This data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.

Original languageEnglish (US)
Pages (from-to)57-64
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume61
Issue number1
DOIs
StatePublished - Jul 2006

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Thrombophilia
Hemorrhagic Shock
Resuscitation
Swine
Partial Thromboplastin Time
Prothrombin Time
Splenectomy
Fibrinogen
Central Venous Catheterization
Thrombelastography
Ringer's lactate
Trauma Centers
Reference Values
Weights and Measures
Liver
Wounds and Injuries

Keywords

  • Coagulation
  • Ringers
  • Saline
  • Thrombelastogram
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model. / Kiraly, Laszlo N.; Differding, Jerome A.; Enomoto, T. Miko; Sawai, Rebecca S.; Muller, Patrick J.; Diggs, Brian; Tieu, Brandon; Englehart, Michael S.; Underwood, Samantha; Wiesberg, Tracy T.; Schreiber, Martin.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 61, No. 1, 07.2006, p. 57-64.

Research output: Contribution to journalArticle

Kiraly, Laszlo N. ; Differding, Jerome A. ; Enomoto, T. Miko ; Sawai, Rebecca S. ; Muller, Patrick J. ; Diggs, Brian ; Tieu, Brandon ; Englehart, Michael S. ; Underwood, Samantha ; Wiesberg, Tracy T. ; Schreiber, Martin. / Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 61, No. 1. pp. 57-64.
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abstract = "BACKGROUND: Lactated ringers (LR) and normal saline (NS) are used interchangeably in many trauma centers. The purpose of this study was to compare the effects of LR and NS on coagulation in an uncontrolled hemorrhagic swine model. We hypothesized resuscitation with LR would produce hypercoagulability. METHODS: There were 20 anesthetized swine (35 ± 3 kg) that underwent central venous and arterial catheterization, celiotomy, and splenectomy. After splenectomy blinded study fluid equal to 3 mL per gram of splenic weight was administered. A grade V liver injury was made and animals bled without resuscitation for 30 minutes. Animals were resuscitated with the respective study fluid to, and maintained, at the preinjury MAP until study end. Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and fibrinogen were collected at baseline (0′) and study end (120′). Thrombelastography was performed at 0′and postinjury at 30′, 60′, 90′, and 120′. RESULTS: There were no significant baseline group differences in R value, PT, PTT, and fibrinogen. There was no significant difference between baseline and 30 minutes R value with NS (p = 0.17). There was a significant R value reduction from baseline to 30 minutes with LR (p = 0.02). At 60 minutes, R value (p = 0.002) was shorter while alpha angle, maximum amplitude, and clotting index were higher (p <0.05) in the LR versus the NS group. R value, PT, and PTT were significantly decreased at study end in the LR group compared with the NS group (p <0.05). Overall blood loss was significantly higher in the NS versus LR group (p = 0.009). CONCLUSIONS: This data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.",
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AU - Kiraly, Laszlo N.

AU - Differding, Jerome A.

AU - Enomoto, T. Miko

AU - Sawai, Rebecca S.

AU - Muller, Patrick J.

AU - Diggs, Brian

AU - Tieu, Brandon

AU - Englehart, Michael S.

AU - Underwood, Samantha

AU - Wiesberg, Tracy T.

AU - Schreiber, Martin

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N2 - BACKGROUND: Lactated ringers (LR) and normal saline (NS) are used interchangeably in many trauma centers. The purpose of this study was to compare the effects of LR and NS on coagulation in an uncontrolled hemorrhagic swine model. We hypothesized resuscitation with LR would produce hypercoagulability. METHODS: There were 20 anesthetized swine (35 ± 3 kg) that underwent central venous and arterial catheterization, celiotomy, and splenectomy. After splenectomy blinded study fluid equal to 3 mL per gram of splenic weight was administered. A grade V liver injury was made and animals bled without resuscitation for 30 minutes. Animals were resuscitated with the respective study fluid to, and maintained, at the preinjury MAP until study end. Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and fibrinogen were collected at baseline (0′) and study end (120′). Thrombelastography was performed at 0′and postinjury at 30′, 60′, 90′, and 120′. RESULTS: There were no significant baseline group differences in R value, PT, PTT, and fibrinogen. There was no significant difference between baseline and 30 minutes R value with NS (p = 0.17). There was a significant R value reduction from baseline to 30 minutes with LR (p = 0.02). At 60 minutes, R value (p = 0.002) was shorter while alpha angle, maximum amplitude, and clotting index were higher (p <0.05) in the LR versus the NS group. R value, PT, and PTT were significantly decreased at study end in the LR group compared with the NS group (p <0.05). Overall blood loss was significantly higher in the NS versus LR group (p = 0.009). CONCLUSIONS: This data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.

AB - BACKGROUND: Lactated ringers (LR) and normal saline (NS) are used interchangeably in many trauma centers. The purpose of this study was to compare the effects of LR and NS on coagulation in an uncontrolled hemorrhagic swine model. We hypothesized resuscitation with LR would produce hypercoagulability. METHODS: There were 20 anesthetized swine (35 ± 3 kg) that underwent central venous and arterial catheterization, celiotomy, and splenectomy. After splenectomy blinded study fluid equal to 3 mL per gram of splenic weight was administered. A grade V liver injury was made and animals bled without resuscitation for 30 minutes. Animals were resuscitated with the respective study fluid to, and maintained, at the preinjury MAP until study end. Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and fibrinogen were collected at baseline (0′) and study end (120′). Thrombelastography was performed at 0′and postinjury at 30′, 60′, 90′, and 120′. RESULTS: There were no significant baseline group differences in R value, PT, PTT, and fibrinogen. There was no significant difference between baseline and 30 minutes R value with NS (p = 0.17). There was a significant R value reduction from baseline to 30 minutes with LR (p = 0.02). At 60 minutes, R value (p = 0.002) was shorter while alpha angle, maximum amplitude, and clotting index were higher (p <0.05) in the LR versus the NS group. R value, PT, and PTT were significantly decreased at study end in the LR group compared with the NS group (p <0.05). Overall blood loss was significantly higher in the NS versus LR group (p = 0.009). CONCLUSIONS: This data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.

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KW - Ringers

KW - Saline

KW - Thrombelastogram

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