1172: EVALUATION OF SHELF-STABLE BLOOD PRODUCTS FOR RESUSCITATION IN A CANINE MODEL OF HEMORRHAGIC SHOCK

Introduction: Hemorrhagic shock is a major cause of morbidity and mortality in trauma patients. Current resuscitation methods use blood products that require temperature control and have a limited lifespan, which present significant limitations for use in rural areas and combat zones. This study examined whether shelf stable blood product resuscitation strategies leveraging freeze-dried plasma (FDP), hemoglobin based oxygen carrier (HBOC), and lyophilized platelets (LP) provide an alternative to conventional resuscitation strategies in a canine model. We hypothesized that a combination of HBOC and FDP with or without LP would be non-inferior to chilled whole blood (CWB) for hemorrhagic shock resuscitation. Methods: Seven dogs were anesthetized and subjected to controlled hemorrhage of up to 40% of their blood volume (T0) over one hour to achieve a mean arterial blood pressure of 35-50 mmHg. They were maintained in shock for 45 minutes and were then randomized to receive: CWB, FDP+HBOC, or FDP+HBOC+LP over 30 minutes (T105-135). Citrated blood was collected at T0, T105, T135, and T180 for thromboelastography (TEG 5000). Samples were run in duplicates with kaolin activation to measure reaction time (r), kinetic time (k), alpha angle (alpha), and maximum amplitude (MA). Between-group comparisons were performed using a Kruskal-Wallis ANOVA and a Bonferroni correction. Results are reported as mean +/- standard deviation. Results: There was no difference in baseline parameters between groups or in TEG values between groups at the end of shock T0 and T105. There was a difference in alpha and MA between groups at T135 (p= 0.02 for both) and T180 (p=0.02 and 0.002, respectively). Specifically, alpha and MA were lower in the FDP+HBOC+LP group (alpha: 54.9 +/- 6.6 deg; MA: 43.5 +/- 11.5 mm) than in the CWB group (alpha: 64.4 +/- 5.2 deg; MA: 58.2 +/- 5.1 mm). There was no difference in r, alpha, and k between groups at any time point. Conclusions: In this canine model of controlled hemorrhage, TEG parameters between FDP+HBOC and CWB were not different. We demonstrated evidence of reduced coagulation function in FDP+HBOC+LP. The biological relevance of those findings should be determined in an uncontrolled hemorrhage model. Resuscitation with shelf-stable products appeared safe and satisfactory in this model.