Page 55 - JSOM Fall 2023

TABLE 2 ROTEM Clot Formation Parameters for Bolus and Infusion Groups Measured Using EXTEM at Baseline and During Resuscitation
Using Whole Blood and Plasma*
Baseline T0 T30 T60 T120 T180
Whole Blood EXTEM Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD
Bolus CT (s) 59.6 7.5 53.8 7.4 57.4 11.1 97 31.6 56.6 10.1 58.8 12.4
CFT (s) 56.6 10.4 53.2 9.7 76 7.3 61.3 17.3 92.4 15.7 84.8 12.6
MCF (mm) 73 3.3 72.7 4.1 70 2.4 61.3 2.6 68.4 4.6 69.8 3.6
LI30 (%) 99.4 0.9 99.6 0.7 100 0 69.1 8.4 100 0 100 0
Infusion CT (s) 57.8 5.2 56.2 8.9 61.7 6.9 93.7 21.5 57.1 11.3 61.9 7.8
CFT (s) 58.3 11.8 87.8 102.7 80.2 10.7 69.3 4.3 84.7 13.8 77.6 13.8
MCF (mm) 72.8 4.2 68.6 12.6 70.9 3 61.3 2.4 71.1 3.3 71.4 3.7
LI30 (%) 100 0 99.8 0.4 100 0 — — 100 0 100 0
Plasma EXTEM Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD
Bolus CT (s) 56.9 5.3 49.4 4.8 52.4 7.5 55.4 6.7 55.4 6.7 49.5 6.8
CFT (s) 272.9 177.1 542.8 551.5 2945.5 1131 1810 0 3253.5 1979 1957 0
MCF (mm) 24.8 4.5 22.9 3.7 17.1 2.5 16.5 2.4 16.2 3.4 17.8 3.3
LI30 (%) 99.9 0.3 100 0 99.9 0.4 98.4 3.8 100 0 99.8 0.5
Infusion CT (s) 58.6 5.7 49.8 5.4 54.2 9 59.4 4.3 58.4 6.1 54.9 5.4
CFT (s) 641.6 329.2 973.8 641.8 2235.5 874.7 — — 2580.3 890.8 1318.3 643.6
MCF (mm) 22.9 2.3 19.7 2.8 16.4 2 15.2 1.0 18.1 1.5 19.3 2.8
LI30 (%) 100 0 99.7 1 98.8 1.9 100 0 99.9 0.4 100 0
*Two-way repeated measures ANOVA with Tukey adjustment revealed no statistical difference between bolus and infusion group ROTEM pa-
rameters at individual time points.
T# denotes time after onset of fluid resuscitation in minutes.
ANOVA, analysis of variance; CFT, clot formation time; CT, clotting time; LI30%, lysis index at 30 minutes after MCF; MCF, maximal clot
firmness; ROTEM, rotational thromboelastometry
p < .001). This difference was attributable to significantly in- Vital Organ Blood Flow
creased MAP at 30 and 60 minutes specifically (RM ANOVA Vital organ blood flow was measured using colored micro-
treatment group interaction effect, p = .002), where MAP was sphere injection and reported in mL/min/g tissue for brain,
increased by an average of 18.6mmHg and 30.2mmHg with ileum, kidney, and myocardium (Figure 4). Vital organ blood
infusion compared with bolus, respectively (Figure 2A). Over- flow tended to decrease from baseline during hemorrhage in
all mean cardiac output measured by thermodilution during all groups, and there was no significant effect of treatment
resuscitation peaked later with infusion compared with bolus group on vital organ blood flow during resuscitation (RM
but was not statistically different between treatment groups ANOVA treatment group p values >.09). Overall, there were
(RM ANOVA treatment group effect, p = .28) (Figure 2B). no detrimental effects of infusion on vital organ blood flow
Overall mean (SD) arterial lactate concentration during resus- compared with bolus.
citation was decreased with infusion at 2.6 (2.5) mmol/L com-
pared with bolus at 4.2 (3.5) mmol/L (RM ANOVA treatment The First 60 Minutes
group effect, p < .001). There were no significant individual Using the same polytrauma model, we previously reported
differences in lactate concentration between groups at specific that adding vasopressin to Hextend boluses had the effect of
time points (RM ANOVA interaction effect, p = .32) (Figure increasing systemic blood pressure and intraperitoneal blood
2C). These data suggest that improvements in hemodynamics loss. However, this behavior was different with the current
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with infusion translated to improved metabolic resuscitation experiments where MAP was paradoxically increased, and
compared with bolus. blood loss decreased in the infusion group. To investigate this
finding in more detail, we resampled MAP data from avail-
Cerebral Resuscitation able continuous Biopac Systems data every 30 seconds for the
Mean ICP was increased overall during resuscitation with in- first 60 minutes of fluid resuscitation and compared the MAP
fusion at 10.6mmHg compared with bolus at 5.9mmHg (RM differences between the infusion and bolus groups (Figure 5).
ANOVA treatment group, p < .001). However, elevations of We found that during the first bolus, from 0 to 10 minutes,
ICP did not reach the critical threshold of >20mmHg, and mean (SD) MAP was significantly increased, with bolus at 33.2
there were no individual times when ICP was different during (11.8)mmHg versus infusion at 28.8 (12.7)mmHg (ANOVA
resuscitation (RM ANOVA treatment group × protocol time group, p = .001). During the 10- to 40-minute period fol-
interaction, p = .26) (Figure 3). Mean overall cerebral perfusion lowing the first bolus, MAP was significantly decreased, with
pressure, calculated as MAP minus ICP, was also significantly bolus at 41.4 (13.8)mmHg versus infusion at 52.0 (17.1)
increased during resuscitation at 36.4mmHg with infusion ver- mmHg (ANOVA group, p < .001). During the second bolus
sus 31.3mmHg with bolus treatment (RM ANOVA treatment at 40 to 50 minutes, MAP remained significantly decreased,
group, p = .015). Again, there were no individual differences at with bolus at 54.1 (20.5)mmHg versus infusion at 58.5 (19.4)
specific time points measured for cerebral perfusion pressure mmHg (ANOVA group, p = .038). MAP remained decreased,
(RM ANOVA treatment group × protocol time interaction, with bolus at 48.4 (20.7)mmHg versus infusion at 59.4 (22.0)
p = .43). These results suggest that infusion supported cerebral mmHg, until the end of infusion at 60 minutes (ANOVA group,
hemodynamics marginally better than bolus did. p < .001). These data suggest that increased systemic blood

IV Infusion of a DCR Cocktail Decreases Blood Loss in a Pig Model | 53