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Shaheen Wirk, MD, MBA; Steven N. Vaslef, MD, PhD

Arch Surg. 2004;139:55-60.

Hypothesis  Pyridoxalated hemoglobin polyoxyethylene conjugate (PHP), a hemoglobin-based oxygen carrier, is effective in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage but may be less effective in off-loading oxygen at the tissue level.

Design  Before-after trial.

Setting  Animal research laboratory of an academic institution.

Participants  Ten female Yorkshire swine.

Interventions  Anesthetized swine underwent a 25% controlled hemorrhage followed by resuscitation with crystalloid plus either shed blood or PHP. Hemodynamic parameters, including heart rate, mean arterial pressure, mean pulmonary arterial pressure, and cardiac index were continuously monitored. Arterial and mixed venous blood samples were collected at baseline, after hemorrhage, after resuscitation, and every 15 minutes for 90 minutes after resuscitation. Oxygen delivery and consumption, oxygen extraction ratios, and percentage of contribution to oxygen delivery and consumption were determined in whole blood, red blood cells, and plasma by using a compartmentalized approach.

Main Outcome Measures  Intergroup and intragroup comparisons were performed for hemodynamic parameters and oxygen transport dynamics.

Results  Heart rate returned closer to baseline levels in the PHP group (P<.05) and mean pulmonary arterial pressure was transiently elevated after infusion of PHP (P = .028), but otherwise no significant differences in hemodynamic balance were observed. The extraction ratio from the red blood cells in the PHP group more than doubled, whereas the extraction ratio from plasma remained constant. The percentage of contribution of plasma, including PHP, to oxygen delivery exceeded 20% (P < .05), but the relative contribution to oxygen consumption did not markedly change from baseline.

Conclusions  Pyridoxalated hemoglobin polyoxyethylene conjugate is at least as effective as shed blood in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage. There is a disproportionately low contribution from plasma to oxygen consumption, which suggests that PHP may act as an oxygen sink in moderate anemia.

From the Department of Surgery, Duke University School of Medicine, Durham, NC.

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