Summary
Trauma is the most common cause of death in young individuals in the industrialized world. One third of all trauma deaths take place within minutes to hours after injury. In this patient group, hemorrhage is a common cause of death. One important part of early treatment in trauma is i.v. administration of crystalloid and/or colloid resuscitation fluids to prevent the development of hemorrhagic/hypovolemic shock. While such fluids can restore blood volume, they cannot transport oxygen to the tissues. Ensuing tissue ischemia leads to anaerobic metabolism and to accumulation of toxic metabolites. This can, in turn, develop into irreversible shock and death. It would thus be advantageous if resuscitation fluids given on the scene not only restored loss of blood volume, but also could carry oxygen and deliver it to the tissues. In hospital blood for transfusion is not always readily available and typing and crossmatching can be time-consuming and costly. Consequently, in the hospital setting and during emergency surgery a resuscitation fluid that could deliver oxygen could be of value. Hemospan, a newly designed hemoglobin-based artificial oxygen carrier, has been tested in two different large animal hemorrhagic shock models. Normalization of hemodynamic as well as metabolic parameters was achieved without any signs of the detrimental vasoactivity seen with earlier hemoglobin-based products. Survival time also increased, even in comparison with autologous blood transfusions.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Trunkey DD (1983) Trauma. Sci Am 249:28–35
Brismar B (1996) Trauma care organization in Sweden. In: Risberg B (ed) Trauma care—an update. Pharmacia & Upjohn, Göteborg, pp 3–4
Wladis A (2001) Hypothermia and trauma. Thesis, Karolinska University Press Stockholm, Sweden, pp 10–14
Regel G, Tscherne H (1996) Trauma care organization in Germany. In: Risberg B (ed) Trauma care—an update. Pharmacia & Upjohn, Göteborg, pp 12–17
MacKenzie EJ, Siegel JH, Shapiro S, et al (1988) Functional recovery and medical costs of trauma: an analysis by type and severity of injury. J Trauma 28:281–297
Kreimeier U, Messmer K (1996) Regional blood flow and oxygen delivery in shock. In: Risberg B (ed) Trauma care—an update. Pharmacia & Upjohn, Göteborg, pp 104–117
Haljamäe H (1996) Crystalloids vs colloids. In: Risberg B (ed) Trauma care—an update. Pharmacia & Upjohn, Göteborg, pp 129–141
Mattox KL, Maningas PA, Moore EE, et al (1991) Prehospital hypertonic saline/Dextran infusion for post-traumatic hypotension. Ann Surg 213:482–491
Wade CE, Kramer GC, Grady JJ, et al (1997) Efficacy of hypertonic 7.5% saline and 6% Dextran-70 in treating trauma: a meta-analysis of controlled clinical studies. Surgery 122:609–616
Riddez L, Drobin D, Sjöstrand F, et al (2002) Lower dose of hypertonic saline dextran reduces the risk of lethal rebleeding in uncontrolled hemorrhage. Shock 17:377–382
Kjellström BT (2003) Blood substitutes: where do we stand today? J Int Med 253:495–497
Squires JE (2002) Artificial blood. Science 295:1002–1005
Chang TMS (1997) Blood substitutes: principles, methods, products and clinical trials. vol. 1. Karger, Basel, 82–87
Chang TMS (1997) Blood substitutes: principles, methods, products and clinical trials. vol. 1. Karger, Basel, 9–31
Ivanitsky GR (2001) Biophysics at the turn of the millennium: perfluorocarbon media and gas-transporting blood substitutes. Biophysics 46:1–31
Edwards G, Levien L, Benn C (2003) Oxygen therapeutic Hemopure in breast cancer reconstructive surgery. Artif Blood 11:38
Kreimeier U, Thiel M, Messmer K (1996) Hypertonic-hyperoncotic solutions. In: Risberg B (ed) Trauma care—an update, Pharmacia & Upjohn, Göteborg, pp 142–153
Sloan EP, Koenigsberg M, Gens D, et al (1999) Diaspirin cross-linked hemoglobin (DCLHb) in the treatment of severe traumatic hemorrhagic shock. A randomized controlled efficacy trial. JAMA 282:1857–1864
Winslow RM (2000) αα-Crosslinked hemoglobin: was failure predicted by preclinical testing? Vox Sang 79:1–20
Migita R, Gonzales A, Gonzales ML, et al (1997) Blood volume and cardiac index in rats after exchange transfusion with hemoglobin-based oxygen carriers. J Appl Physiol 82:1995–2002
Winslow RM, Gonzales A, Gonzales ML, et al (1998) Vascular resistance and the efficacy of red cell substitutes in a rat hemorrhage model. J Appl Physiol 85:993–1003
Vandegriff KD, Lohman JM, Tsai AG, et al (2000) Hemospan, a non-hypertensive, high-blood flow red cell substitute. Proc VIII Internat’nl Symp Blood Subst, San Diego, USA, p 23
Drobin D, Lohman J, Malm E, et al (2003) Increased survival time during second hemorrhage when first hemorrhage is resuscitated with Hemospan compared to blood or colloid. Artif Blood 11:89
Kjellström BT, Drobin D, Malm E, et al (2003) Hemodynamic and metabolic changes after administration of PEG-Hb in hemorrhagic shock in swine. Artif Blood 11:70
Drobin D, Kjellström BT, Malm E, et al (2004) Hemodynamic response and oxygen transport in pigs resuscitated with maleimide-polyethylene glycol-modified hemoglobin (MPH). J Appl Physiol 96:1843–1854
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag Tokyo
About this paper
Cite this paper
Kjellström, B.T. (2005). Possible Role of Artificial Oxygen Carriers in Shock and Trauma. In: Kobayashi, K., Tsuchida, E., Horinouchi, H. (eds) Artificial Oxygen Carrier. Keio University International Symposia for Life Sciences and Medicine, vol 12. Springer, Tokyo. https://doi.org/10.1007/4-431-26651-8_20
Download citation
DOI: https://doi.org/10.1007/4-431-26651-8_20
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-22074-9
Online ISBN: 978-4-431-26651-8
eBook Packages: MedicineMedicine (R0)