Rabbit model of uncontrolled hemorrhagic shock and hypotensive resuscitation

Clinically relevant animal models capable of simulating traumatic hemorrhagic shock are needed. We developed a hemorrhagic shock model with male New Zealand rabbits (2200-2800 g, 60-70 days old) that simulates the pre-hospital and acute care of a penetrating trauma victim in an urban scenario using current resuscitation strategies. A laparotomy was performed to reproduce tissue trauma and an aortic injury was created using a standardized single puncture to the left side of the infrarenal aorta to induce hemorrhagic shock similar to a penetrating mechanism. A 15-min interval was used to simulate the arrival of pre-hospital care. Fluid resuscitation was then applied using two regimens: normotensive resuscitation to achieve baseline mean arterial blood pressure (MAP, 10 animals) and hypotensive resuscitation at 60 percent of baseline MAP (10 animals). Another 10 animals were sham operated. The total time of the experiment was 85 min, reproducing scene, transport and emergency room times. Intra-abdominal blood loss was significantly greater in animals that underwent normotensive resuscitation compared to hypotensive resuscitation (17.1 ± 2.0 vs 8.0 ± 1.5 mL/kg). Antithrombin levels decreased significantly in normotensive resuscitated animals compared to baseline (102 ± 2.0 vs 59 ± 4.1 percent), sham (95 ± 2.8 vs 59 ± 4.1 percent), and hypotensive resuscitated animals (98 ± 7.8 vs 59 ± 4.1 percent). Evidence of re-bleeding was also noted in the normotensive resuscitation group. A hypotensive resuscitation regimen resulted in decreased blood loss in a clinically relevant small animal model capable of reproducing hemorrhagic shock caused by a penetrating mechanism.

Manejo de líquidos en el shock traumático / Liquid management in traumatic shock

La injuria traumática puede alterar de muchas maneras la relación transporte de oxígeno/consumo de oxígeno, pudiendo conducir a una situación de shock. El uso de fluidos de reanimación intravenosa durante el tratamiento inicial puede restablecer la perfusión a nivel tisular, mejorando el transporte de oxígeno arterial. Luego de la evaluación inicial debe iniciarse la resucitación con la infusión de 2000 ml de soluciones cristaloides en el adulto, y/o de 20 ml/kg en el paciente pediátrico. En muchos casos debe adicionarse sangre y/o soluciones coloidales para mantener la hemodinamia. El cuidadoso monitoreo del paciente, incluso con la medición de PVC, PWCP, TAM, etc., permite brindarle la mejor opción de tratamiento.