Bovine Polymerized Hemoglobin (HBOC-201) for the Prehospital Resuscitation of Combat Casualties with Hemorrhagic Shock (HS)

OBJECTIVES: To compare the physiologic effects of BPH vs. hetastarch (HEX), the current resuscitative fluid used by U.S. Special Forces, in delayed resuscitation HS models simulating battlefield injuries. METHODS: After induction of HS in controlled (catheter withdrawal) and uncontrolled (liver injury) hemorrhage swine models, the effects of BPH, HEX, and no resuscitation (NON), followed by hospital-like care after a 4 hour "evacuation delay", were compared. Standard physiologic parameters were followed for 72 hours. Hemostasis was evaluated by routine coagulation assays, thromboelastography, collagen/ADP- coated membrane aperture closing time, and platelet aggregation ADP-release. Leukocyte adhesion and immunophenotype were compared using FACS. Plasma cytokines were assayed by ELISA and Western Blot. RESULTS: In controlled HS, 100% (8/8) of BPH, 88% (7/8) of HEX, and 63% (5/8) of NON pigs, survived to