Hypertonic acetate dextran achieves high-flow-Low-pressure resuscitation of hemorrhagic shock

Objective: For resuscitation of hemorrhagic hypovolemia, we compared the effectiveness of (1) isotonic lactated Ringer's solution (LRS), (2) 2400 mOsm of 7.5% NaCl:6% dextran 70 (HSD), and (3) 2400 mOsm of 7.9% sodium acetate:1.9% NaCl:6% dextran 70 (HAD). Design: In six randomized, blinded experiments for each solution, conscious instrumented adult sheep were hemorrhaged by removing ~1.8 L (42 ± 3 mL/kg) of blood, while maintaining the mean arterial pressure (MAP) at 50 mm Hg for 2 hours. Methods: Test solutions were infused as needed to restore the cardiac index to baseline. Results: Volume requirements with HAD (236 ± 29 mL) and HSD (244 ± 39 mL) were significantly less (p < 0.05) than LRS (3463 ± 234 mL). Mean arterial pressure was normalized with HSD and LRS, but not with HAD, which resulted in MAPs of 20 to 25 mm Hg less than baseline resulting from a reduced peripheral resistance. Oxygen delivery, however, was significantly higher with HAD during the resuscitation period. Acid-base balance (pH) and oxygen consumption were normalized within 5 minutes of infusion only with HAD. Conclusions: Small-volume infusion with HAD resulting in 'high-flow-low-pressure' resuscitation may offer unique hemodynamic and metabolic advantages for the initial treatment of hemorrhage from trauma.