Whole blood and hypertonic saline resuscitation improve the outcomes of controlled hemorrhagic shock combined with penetrating brain injury in rat

One of the most frequent injury patterns leading to early death of polytraumatized patients is hemorrhagic shock combined with traumatic brain injury. Currently, there is no agreement on the best treatment protocol of such injury. This study was aimed to compare the outcomes of resuscitation with various volumes of hypertonic saline (HTS), whole blood (WB) and fresh frozen plasma (FFP) in a rat model of penetrating brain injury combined with controlled hemorrhagic shock in order to look for optimal treatment. Anesthetized rats were intubated and ventilated. 30% of circulating blood volume was withdrawn following open brain injury, and intravenous resuscitation with various volumes of HTS, WB and FFP (3, 9, and 18 ml/kg) was administered. Blood samples were collected during the experiment for measurements of lactate and base excess levels, and before sacrifice for neutrophil counts. Twenty four and 48 hours after the injury, rat’s neurological status was examined. Rats were, then, sacrificed and pathological studies of brain and lung sections were performed. Regardless of fluid type, resuscitation improved the mean arterial pressure and lactate levels in accordance to fluid's volume. However, base excess was improved only when rats were treated with WB and FFP. Improvement in behavioral performance of the rats was observed when treated with 3 and 9 ml/kg HTS or with 18 ml/kg WB or FFP. Blood and lung neutrophils were reduced in rats treated with 9 or 18 ml/kg WB. Mortality rates were reduced in rats administered with 9 and 18 ml/kg of HTS or WB. Taken together, resuscitation with WB at 9-18ml/kg or HTS at 9ml/kg is optimal for treatment of combined injury.