Resuscitation with centhaquin and 6% hydroxyethyl starch 130/0.4 improves survival in a swine model of hemorrhagic shock: a randomized experimental study
- 57 Downloads
To investigate the effects of the combination of centhaquin and 6% hydroxyethyl starch 130/0.4 (HES 130/0.4) in a swine model of hemorrhagic shock.
Twenty Landrace–Large White pigs were instrumented and subjected to hemorrhagic shock. The animals were randomly allocated in two experimental groups, the control (group CO, n = 10) and the centhaquin groups (0.015 mg/kg, n = 10, group CH). Acute hemorrhage was induced by stepwise blood withdrawal (18 mL/min) from the internal jugular vein until MAP decreased to 40–45 mmHg, whereas anesthesia remained constant. All animals received HES 130/0.4 solution in the resuscitation phase until their mean arterial pressure (MAP) reached 90% of the baseline. The animals were observed for 60 min, during which no further resuscitation was attempted.
The total amount of blood and the bleeding time did not differ significantly between group CO and group CH (120 ± 13 vs. 120 ± 14 mL, p = 0.6; 20 ± 2 vs. 20 ± 1 min, p = 0.62, respectively). During the hemorrhagic phase, only a difference in heart rate (97.6 ± 4.4 vs. 128.4 ± 3.6 beats/min, p = 0.038) was observed between the two groups. The time required to reach the target MAP was significantly shorter in the centhaquin group compared to controls (13.7 ± 0.4 vs. 19.6 ± 0.84 min, p = 0.012). During the resuscitation phase, a statistical significant difference was observed in MAP (75.2 ± 1.6 vs. 89.8 ± 2.1 mmHg, p = 0.02) between group CO and group CH. During the observation phase, a statistical significant difference was observed in SVR (1109 ± 32.65 vs. 774.6 ± 21.82 dyn s/cm5, p = 0.039) and cardiac output (5.82 ± 0.31 vs. 6.9 ± 0.78 L/min, p = 0.027) between the two groups. Two animals of group CO and seven animals of group CH survived for 24 h (p = 0.008). We observed a marked increase in microvascular capillary permeability in group CO compared to group CH, with the wet/dry weight ratio being significantly higher in group CO compared to group CH (4.8 ± 1.6 vs. 3.08 ± 0.6, p < 0.001).
The combination of centhaquin 0.015 mg/kg and HES 130/0.4 resulted in shorter time to target MAP, lower wet-to-dry ratio, and better survival rates after resuscitation from hemorrhagic shock.
KeywordsHemorrhagic shock Centhaquin Hydroxyethyl starch Acute care anesthesiology Emergency surgery Survival
This study was supported by the Experimental-Research Center ELPEN Pharmaceuticals (E.R.C.E), Athens, Greece by providing the research facilities for this project. We would like to thank, A. Zacharioudaki, E. Karampela, K. Tsarea, M. Karamperi, N. Psychalakis, A. Karaiskos, S. Gerakis and E. Gerakis, staff members of the E.R.C.E., for their assistance during the experiments.
Compliance with ethical standards
Conflict of interest
Zinais Kontouli, Chryssoula Staikou, Nicoletta Iacovidou, Ioannis Mamais, Evaggelia Kouskouni, Apostolos Papalois, Panagiotis Papapanagiotou, Anil Gulati, Athanasios Chalkias, and Theodoros Xanthos declare that they have no conflict of interest.
All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.
Non-applicable. We did not include patients in this study.
- 4.Bunn F, Alderson P, Hawkin V. Colloid solution for fluid resuscitation. Cochrane database Syst Rev. 2000;2:CD001319.Google Scholar
- 5.Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2012;6:CD000567.Google Scholar
- 7.Burns JW, Baer LA, Darlington DN, Dubick MA, Wade CE. Screening of potential small volume resuscitation products using a severe hemorrhage sedated swine model. Int J Burn Trauma. 2012;2:59–67.Google Scholar
- 8.Rizolli SB. Crystalloids and colloids in trauma resuscitation: a brief overview of the current debate. J Trauma. 2003;54:82–8.Google Scholar
- 25.Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2013;2:CD000567.Google Scholar
- 26.Annane D, Siami S, Jaber S, Martin C, Elatrous S, Declère AD, et al. CRISTAL Investigators. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA. 2013;310:1809–17.CrossRefPubMedGoogle Scholar
- 47.Chen G, You G, Wang Y, Lu M, Cheng W, Yang J, et al. Effects of synthetic colloids on oxidative stress and inflammatory response in hemorrhagic shock: comparison of hydroxyethyl starch 130/0.4, hydroxyethyl starch 200/0.5, and succinylated gelatin. Crit Care. 2013;17:R141.CrossRefPubMedPubMedCentralGoogle Scholar