Resuscitation from severe hemorrhage

William C. Shoemaker, Andrew B. Peitzman, Ronald Bellamy, Rinaldo Bellomo, Stephen P. Bruttig, Antonio Capone, Michael Dubick, George Kramer, Jack E. McKenzie, Paul E. Pepe, Peter Safar, Robert Schlichtig, John W. Severinghaus, Samuel A. Tisherman, Lars Wiklund

Research output: Contribution to journalArticle

157 Citations (Scopus)

Abstract

The potential to be successfully resuscitated from severe traumatic hemorrhagic shock is not only limited by the "golden 1 hr," but also by the "brass (or platinum) 10 mins" for combat casualties and civilian trauma victims with traumatic exsanguination. One research challenge is to determine how best to prevent cardiac arrest during severe hemorrhage, before control of bleeding is possible. Another research challenge is to determine the critical limits of, and optimal treatments for, protracted hemorrhagic hypotension, in order to prevent "delayed" multiple organ failure after hemostasis and all-out resuscitation. Animal research is shifting from the use of unrealistic, pressure-controlled, hemorrhagic shock models and partially realistic, volume-controlled hemorrhagic shock models to more realistic, uncontrolled hemolrhagic shock outcome models. Animal outcome models of combined trauma and shock are needed; a challenge is to find a humane and clinically realistic long-term method for analgesia that does not interfere with cardiovascular responses. Clinical potentials in need of research are shifting from normotensive to hypotensive (limited) fluid resuscitation with plasma substitutes. Topics include optimal temperature, fluid composition, analgesia, and pharmacotherapy. Hypotensive fluid resuscitation in uncontrolled hemorrhagic shock with the addition of moderate resuscitatiye (28° to 32°C) hypothermia looks promising in the laboratory. Regarding the composition of the resuscitation fluid, despite encouraging results with new preparations of stroma-free hemoglobin and hypertonic salt solutions with colloid, searches for the optimal combination of oxygen-carrying blood substitute, colloid, and electrolyte solution for limited fluid resuscitation with the smallest volume should continue. For titrating treatment of shock, blood lactate concentrations are of questionable value, although metabolic acidemia seems helpful for prognostication. Development of devices for early noninvasive monitoring of multiple parameters in the field is indicated. Molecular research applies more to protracted hypovolemic shock followed by the systemic inflammatory response syndrome or septic shock, which were not the major topics of this discussion.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume24
Issue number2 SUPPL.
StatePublished - 1996
Externally publishedYes

Fingerprint

Resuscitation
Hemorrhagic Shock
Hemorrhage
Shock
Colloids
Research
Analgesia
Plasma Substitutes
Traumatic Shock
Exsanguination
Hypertonic Solutions
Blood Substitutes
Systemic Inflammatory Response Syndrome
Multiple Organ Failure
Wounds and Injuries
Septic Shock
Heart Arrest
Platinum
Hemostasis
Hypothermia

Keywords

  • Fluid therapy
  • Hemorrhagic shock
  • Hypovolemic shock
  • Monitoring, physiologic
  • Resuscitation
  • Uncontrolled hemorrhagic shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Shoemaker, W. C., Peitzman, A. B., Bellamy, R., Bellomo, R., Bruttig, S. P., Capone, A., ... Wiklund, L. (1996). Resuscitation from severe hemorrhage. Critical Care Medicine, 24(2 SUPPL.).

Resuscitation from severe hemorrhage. / Shoemaker, William C.; Peitzman, Andrew B.; Bellamy, Ronald; Bellomo, Rinaldo; Bruttig, Stephen P.; Capone, Antonio; Dubick, Michael; Kramer, George; McKenzie, Jack E.; Pepe, Paul E.; Safar, Peter; Schlichtig, Robert; Severinghaus, John W.; Tisherman, Samuel A.; Wiklund, Lars.

In: Critical Care Medicine, Vol. 24, No. 2 SUPPL., 1996.

Research output: Contribution to journalArticle

Shoemaker, WC, Peitzman, AB, Bellamy, R, Bellomo, R, Bruttig, SP, Capone, A, Dubick, M, Kramer, G, McKenzie, JE, Pepe, PE, Safar, P, Schlichtig, R, Severinghaus, JW, Tisherman, SA & Wiklund, L 1996, 'Resuscitation from severe hemorrhage', Critical Care Medicine, vol. 24, no. 2 SUPPL..
Shoemaker WC, Peitzman AB, Bellamy R, Bellomo R, Bruttig SP, Capone A et al. Resuscitation from severe hemorrhage. Critical Care Medicine. 1996;24(2 SUPPL.).
Shoemaker, William C. ; Peitzman, Andrew B. ; Bellamy, Ronald ; Bellomo, Rinaldo ; Bruttig, Stephen P. ; Capone, Antonio ; Dubick, Michael ; Kramer, George ; McKenzie, Jack E. ; Pepe, Paul E. ; Safar, Peter ; Schlichtig, Robert ; Severinghaus, John W. ; Tisherman, Samuel A. ; Wiklund, Lars. / Resuscitation from severe hemorrhage. In: Critical Care Medicine. 1996 ; Vol. 24, No. 2 SUPPL.
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