Intraosseous Hypertonic Saline Solution For Resuscitation Of Hemorrhagic Shock In Canine

Background Hemorrhagic shock is patho-physiology courses characteristic with disruption of microcirculatory flow, cellular hypoxia, and harm to almost all organ systems. Hemorrhagic shock is common and severe complication of trauma patients who involved either military personnel or civilians. The key role of rescue is rapidly establishing effective infusion accesses. During hemorrhagic shock stage, periphery vessel contract and veins clamp down, and it is hard to establish intravenous (IV) access. At the time of outburst emergency such as war conflict, short of medical condition, large number of patients and so on, under such circumstance it is hard to successfully establish IV access. It's estimated that attempts to establish IV access in emergencies fail 10% of the time, and the time it takes to achieve IV access ranges from 1.5 min to more than 10 min, which often miss the optimal time treatment. Under such circumstance, a rapid, safe and reliable means of alternative infusion access is emergency request. As compared with peripheral vine, the marrow cavity provides access to a noncollapsible venous plexus, the infused of medicine and fluid can easily enter into blood flows. Intraosseous access techniques can be used as new means for first aids and fluids resuscitation. Low dose (4ml/kg) hypertonic saline hydroxyethly starch (7.5% sodium chloride and 6% hydroxyethly starch, HSH) is current modern fluid resuscitation concept. The low dose HSH stages resuscitation can stabilized hemodynamic parameters, promoted myocardial contractility, cardiac output and microvascular reactivity, increased perfusion of the microcirculation, modulated the systemic inflammatory response, which isideal resuscitation fluid for patients with hemorrhagic shock. To probe the feasibility and safety of HSH resuscitation effects of hemorrhagic shock through tibia intraosseous infusion access and the change of blood clotting and hemopoiesis function, this study adopt Wiggers graded controlled hemorrhagic shock animal model, through monitor the change of central venous pressure (CVP), mean arterial pressure (MAP) and intraosseous pressure; the change of plasma levels of lactic acid which reflect of tissue and cellular metabolism; the change of content of cytokines of TNF-α, IL-6, IL-8 and IL-4; the change of circulation polymorphonuclear neutrophils (PMN), activated partial thromboplastin time (APTT), activated partial thromboplastin time (PT), erythropoietin (EPO) and the expression CD34~+ of both peripheral blood and bone marrow to compare the resuscitation effects of two kinds of resuscitation fluids (NS, HSH) on hemorrhagic shock canine infused with tibia intraosseous access. Through this experiment, it can be provide scientific experiment basis for intraosseous access technique on remedy of hemorrhagic shock for clinical and battlefield first aids.Result1. During visualization on canine distal tibia, the contrast material rapidly diffused in bone marrow cavity, small vein visualization. The contrast material run through tibia central canal, bone nourish vessel and pour into posterior tibia veins and popliteal vein, then infusion into systemic circulation.2. During hemorrhagic shock stage, the haemodynamics parameter of MAP, CVP and intraosseous pressure, lactic acid and PMN significantly increased as compared with Sham group. In resuscitation phase, the haemodynamics parameter significantly increased, lactic acid level significantly decreased; the sodium level and PMN significantly increased, and the sodium decreased to baseline value after 120 min of resuscitation in HSH group. NS group showed no significantly change on haemodynamics parameter and sustain lower level; blood lactic level significantly increased as compared with Sham group.3. Under conditions of the model, we observed the levels of TNF-α, IL-4, IL-6, and IL-8 in serum were increased significantly after hemorrhagic shock. After 2h of resuscitation, the cytokines level of TNF-α, IL-6, and IL-8 were significantly decreased in HSH group and IL-4 level in HSH group significantly increased as compared with NS group after 48h of resuscitation.4. The experiment groups of percentage of CD34~+ stem cell in both bone marrow and peripheral blood were significantly increased respectively in hemorrhagic shock phrase, 48h and 1 week of resuscitation as compared with Sham group. The level of EPO in serum was slowly increased after hemorrhagic shock, reached peak value after 48h of resuscitation, and decreased after 1 week of resuscitation.5. During hemorrhagic shock phrase, the value of APTT and PT increased in experiment groups. During resuscitation phrase, the value of APTT significantly increased as compared with sham group, and showed no remarkable hemorrhagic tendency. After 48h of resuscitation, the value of APTT and PT decreased to normal value.6. The erythrocyte series in both NS group and HSH group significantly increased after 1 week of resuscitation. In comparison to Sham group, NS group presented a significant increase in granulocytic series, together with a drop in the percentage of lymphocytic and the HSH group had an augmented number of lymphocytic cells. After 4 week of resuscitation, there is no significantly difference in hemopoiesis series among in NS group and HSH group as compared with Sham group. The bone marrow morphology slightly changed, and little bone necrosis occurred.Conclusion1. The low dose infusion of HSH with intraosseous access can rapidly restore haemodynamics parameter, correct hyperlactacidemia; blood clotting function slightly changed, however showed no sign of hemorrhagic tendency. After infusion of HSH, the sodium level temporally increased, however showed noremarkable hypernatremia.2. The study showed that the infusion of low dose HSH with intraosseous access can remarkably restrict inflammatory reaction.3. After low dose infusion of HSH with intraosseous access, the serum level of EPO and the percentage of expression of CD34~+ significantly increased, this was good to mobilized haemopoietic stem cell in bone marrow to periphery blood to maintain stabilization of internal environment. In he mean time, the elevated expression of CD34~+ of MNC may participate tissue repair after trauma.4. Intraosseous access resuscitation showed no remarkably change for bone marrow, and little osteonecrosis occurred. Intraosseous access techniques proved to be a simple technique, high successful puncture rate, less complication, reliable means of alternative IV access.