Prehospital hemoglobin-based oxygen carrier resuscitation attenuates postinjury acute lung injury

Crystalloid infusion has been the standard prehospital fluid resuscitation in the United States for the past 35 years, but the emergence of a safe and effective hemoglobin-based oxygen carrier (HBOC) may change that practice. The purpose of this in vivo study is to simulate an existing multicenter prehospital trial of HBOC versus crystalloid to determine the effects in a controlled 2-event construct of postinjury multiple organ failure. Rats underwent hemorrhagic shock (30 mm Hg × 45 min) and were resuscitated over 2 hours in a clinically relevant design: 2 × volume of shed blood (SB) using normal saline (NS) in the first 30 minutes; 1/2 volume of SB in the next 30 minutes; another 2 × SB volume with NS over the remaining 60 minutes. Study groups represented alternative fluid strategies during the first hour of resuscitation: (1) Inhospital SB (standard resuscitation), (2) Inhospital HBOC, (3) Prehospital SB, and (4) Prehospital HBOC. Global physiologic response was assessed via tissue oxygenation (near infrared spectroscopy) and arterial base deficit, and pulmonary response, via lung polymorphonuclear neutrophil accumulation and vascular permeability. Prehospital HBOC resuscitation provided the most efficient recovery of tissue oxygenation and correction of base deficit, had the greatest reduction in pulmonary polymorphonuclear neutrophil accumulation, and abrogated acute lung injury. Prehospital SB and Inhospital HBOC regimens afforded intermediate lung protection, compared with standard resuscitation. The findings in this controlled in vivo study suggest prehospital HBOC resuscitation improves the recovery from postshock oxygen debt and reduces postinjury organ dysfunction.