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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2010

Open Access 01-12-2010 | Original research

Systemic central venous oxygen saturation is associated with clot strength during traumatic hemorrhagic shock: A preclinical observational model

Authors: Nathan J White, Erika J Martin, Yongyun Shin, Donald F Brophy, Robert F Diegelmann, Kevin R Ward

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2010

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Abstract

Background

Clot strength by Thrombelastography (TEG) is associated with mortality during trauma and has been linked to severity of tissue hypoperfusion. However, the optimal method for monitoring this important relationship remains undefined. We hypothesize that oxygen transport measurements will be associated with clot strength during traumatic shock, and test this hypothesis using a swine model of controlled traumatic shock.

Methods

N = 33 swine were subjected to femur fracture and hemorrhagic shock by controlled arterial bleeding to a predetermined level of oxygen debt measured by continuous indirect calorimetry. Hemodynamics, oxygen consumption, systemic central venous oxygenation (ScvO2), base excess, lactate, and clot maximal amplitude by TEG (TEG-MA) as clot strength were measured at baseline and again when oxygen debt = 80 ml/kg during shock. Oxygen transport and metabolic markers of tissue perfusion were then evaluated for significant associations with TEG-MA. Forward stepwise selection was then used to create regression models identifying the strongest associations between oxygen transport and TEG-MA independent of other known determinants of clot strength.

Results

Multiple markers of tissue perfusion, oxygen transport, and TEG-MA were all significantly altered during shock compared to baseline measurements (p < 0.05). However, only ScvO2 demonstrated a strong bivariate association with TEG-MA measured during shock (R = 0.7, p < 0.001). ScvO2 measured during shock was also selected by forward stepwise selection as an important covariate in linear regression models of TEG-MA after adjusting for the covariates fibrinogen, pH, platelet count, and hematocrit (Whole model R2 = 0.99, p ≤ 0.032).

Conclusions

Among multiple measurements of oxygen transport, only ScvO2 was found to retain a significant association with TEG-MA during shock after adjusting for multiple covariates. ScvO2 should be further studied for its utility as a clinical marker of both tissue hypoxia and clot formation during traumatic shock.
Literature
1.
Brohi K, Singh J, Heron M, Coats T: Acute traumatic coagulopathy. J Trauma. 2003, 54 (6): 1127-1130. 10.1097/01.TA.0000069184.82147.06.CrossRefPubMed
2.
Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF: Traumatic Coagulopathy: Initiated by hypoperfusion. Modulated through the protein C pathway?. Annals of Surgery. 2007, 245 (5): 812-18. 10.1097/01.sla.0000256862.79374.31.PubMedCentralCrossRefPubMed
3.
Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, Pittet J: Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008, 64 (5): 1211-7. 10.1097/TA.0b013e318169cd3c.CrossRefPubMed
4.
Chesebro B, Rahn P, Carles M, Esmon CT, Xu Jun, Brohi K, Frith D, Pittet J, Cohen MJ: Increase in activated protein C mediates acute traumatic coagulopathy in mice. Shock. 2009, 32 (6): 659-665. 10.1097/SHK.0b013e3181a5a632.PubMedCentralCrossRefPubMed
5.
Siegel JH, Rivkind AI, Dalal S, Goodarzi S: Early physiologic predictors of injury severity and death in blunt multiple trauma. Arch Surg. 1990, 125: 498-508.CrossRefPubMed
6.
Rutherford EJ, Morris JA, Reed GW, Hall KS: Base deficit stratifies mortality and determines therapy. J Trauma. 1992, 33: 417-423. 10.1097/00005373-199209000-00014.CrossRefPubMed
7.
Davis JW, Parks SN, Kaups KL, Gladen HE, O'Donnell-Nicol S: Admission base deficit predicts transfusion requirements and risk of complications. J Trauma. 1996, 41: 769-774. 10.1097/00005373-199611000-00001.CrossRefPubMed
8.
Funk GC, Doberer D, Kneidinger N, Lindner G, Holzinger U, Schneeweiss B: Acid-base disturbances in critically ill patients with cirrhosis. Liver international. 2007, 27 (7): 901-909. 10.1111/j.1478-3231.2007.01510.x.CrossRefPubMed
9.
Naka T, Bellomo R, Morimatsu H, Rocktaschel J, Wan L, Gow P, Angus P: Acid-base balance in combined severe hepatic and renal failure: a quantitative analysis. Int J Artificial Organs. 2008, 31 (4): 288-294.
10.
Dunham CM, Watson LA, Cooper C: Base deficit level indicating major injury is increased with ethanol. J Emerg Med. 2000, 18 (2): 165-171. 10.1016/S0736-4679(99)00188-2.CrossRefPubMed
11.
Kaufmann CR, Dwyer KM, Crews JD, Dols SJ, Trask AL: Usefulness of thrombelastography in assessment of trauma patient coagulation. J Trauma. 1997, 42 (4): 716-20. 10.1097/00005373-199704000-00023. discussion 720CrossRefPubMed
12.
Plotkin AJ, Wade CE, Jenkins DH: A reduction in clot formation rate and strength assessed by thrombelastography is indicative of transfusion requirements in patients with penetrating injuries. J Trauma. 2008, 64 (2 Suppl): S64-8. 10.1097/TA.0b013e318160772d.CrossRefPubMed
13.
Rugeri L, Levrat A, David JS, Delecroix E, Floccard B, Gros A, Allaouchiche B, Negrier C: Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. J Thrombosis Hemostasis. 2006, 5: 289-295. 10.1111/j.1538-7836.2007.02319.x.CrossRef
14.
Carroll RC, Craft RM, Langdon RJ, Clanton CR, Snider C, Wellons D, Dakin PA, Lawson CM, Enderson BL, Kurek SJ: Early evaluation of acute traumatic coagulopathy by thrombelastography. Translational Research. 2009, 154 (1): 34-39. 10.1016/j.trsl.2009.04.001.CrossRefPubMed
15.
Levrat A, Gros A, Rugeri L, Inaba K, Floccard B, Negrier C, David JS: Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. British Journal of Anaesthesia. 2008, 100 (6): 792-797. 10.1093/bja/aen083.CrossRefPubMed
16.
Kashuk JL, Moore E: The emerging role of rapid thromboelastography in trauma care. J Trauma. 2009, 67 (2): 417-418. 10.1097/TA.0b013e3181ac9cdc.CrossRefPubMed
17.
Martini WZ, Cortez DS, Dubick MA, Park MS, Holcomb JB: Thrombelastography is better than PT, aPTT, and activated clotting time in detecting clinically relevant clotting abnormalities after hypothermia, hemorrhagic shock and resuscitation in pigs. J Trauma. 2008, 65 (3): 535-43. 10.1097/TA.0b013e31818379a6.CrossRefPubMed
18.
Hartert H, Schaeder JA: The physical and biologic constants of thromboelastography. Biorheology. 1962, 1: 31-9.
19.
Lang T, Johanning K, Metzler H: The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia. Anesthesia & Analgesia. 2009, 108 (3): 751-8.CrossRef
20.
Bowbrick VA, Mikhailidis DP, Stansby G: Value of thromboelastography in the assessment of platelet function. Clin/Appl Thrombosis and Hemostasis. 2003, 9 (2): 137-142.CrossRef
21.
White NJ, Martin EJ, Brophy DF, Ward KR: Coagulopathy and traumatic shock: characterizing hemostatic function during the critical period prior to fluid resuscitation. Resuscitation. 2010, 81 (1): 111-116. 10.1016/j.resuscitation.2009.09.017.PubMedCentralCrossRefPubMed
22.
Baker SP, O'Neill B, Haddon W, Long WB: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974, 14: 187-196. 10.1097/00005373-197403000-00001.CrossRefPubMed
23.
Roesner JP, Koch A, Bateman R: Accurate and continuous measurement of oxygen deficit during haemorrhage in pigs. Resuscitation. 2009, 80: 259-63. 10.1016/j.resuscitation.2008.10.020.CrossRefPubMed
24.
Rixen D, Raum M, Holzgraefe B, Sauerland S, Nagelschmidt M, Neugebauer EA: A pig hemorrhagic shock model: oxygen debt and metabolic acidemia as indicators of severity. Shock. 2001, 16: 239-44. 10.1097/00024382-200116030-00012.CrossRefPubMed
25.
Wasowicz M, Srinivas C, Meineri M, Banks B, McCluskey SA, Karkouti K: Technical report: analysis of citrated blood with thromboelastography: comparison with fresh blood samples. Can J Anaesth. 2008, 55 (5): 284-9. 10.1007/BF03017205.CrossRefPubMed
26.
Velik-Salchner C, Schnrer C, Fries D, Mssigang PR, Moser PL, Streif W, Kolbitsch C, Lorenz IH: Normal values for thrombelastography (ROTEM) and selected coagulation parameters in porcine blood. Thrombosis Research. 2006, 117 (5): 597-602. 10.1016/j.thromres.2005.05.015.CrossRefPubMed
27.
Holmes JF, Sakles JC, Lewis G, Wisner DH: Effects of delaying fluid resuscitation on an injury to the systemic arterial vasculature. Acad Emerg Med. 2002, 9: 267-274. 10.1111/j.1553-2712.2002.tb01317.x.CrossRefPubMed
28.
Ruttmann TG, James MF, Aronson I: In vivo investigation into the effects of haemodilution with hydroxyethyl starch (200/0.5) and normal saline on coagulation. British Journal of Anaesthesia. 1998, 80 (5): 612-616.CrossRefPubMed
29.
Parr MJ, Bouillon B, Brohi K, Dutton RP, Hauser CJ, Hess JR, Holcomb JB, Kluger Y, Mackway-Jones K, Rizoli SB, Yukioka T, Hoyt DB: Traumatic coagulopathy: where are the good experimental models?. J Trauma. 2008, 65 (4): 766-71. 10.1097/TA.0b013e31818606d2.CrossRefPubMed
30.
Munster AB, Olsen AK, Bladbjerg E: Usefulness of human coagulation and fibrinolysis assays in domestic pigs. Comparative Medicine. 2002, 52 (1): 39-43.PubMed
31.
Chandler WL: Procoagulant activity in trauma patients. Am J Clin Pathol. 2010, 134 (1): 90-6. 10.1309/AJCP3WPOYSKK6BFE.CrossRefPubMed
32.
Siller-Matula JM, Plasenzotti R, Spiel A, Quehenberger P, Jilma B: Interspecies differences in coagulation profile. Thromb Haemost. 2008, 100 (3): 397-404.PubMed
33.
Tomori T, Hupalo D, Teranishi K, Michaud S, Hammett M, Freilich D, McCarron R, Arnaud F: Evaluation of coagulation stages of hemorrhaged swine: comparison of thromboelastography and rotational elastometry. Blood Coagul Fibrinolysis. 2010, 21 (1): 20-7. 10.1097/MBC.0b013e32833113e9.CrossRefPubMed
34.
Sapsford W, Watts S, Cooper G, Kirkman E: Recombinant activated factor VII increases survival time in a model of incompressible arterial hemorrhage in the anesthetized pig. J Trauma. 2007, 62 (4): 868-79. 10.1097/ta.0b013e318034204b.CrossRefPubMed
35.
Martini WZ, Chinkes DL, Sondeen J, Dubick MA: Effects of hemorrhage and lactated Ringer's resuscitation on coagulation and fibrinogen metabolism in swine. Shock. 2006, 26 (4): 396-401. 10.1097/01.shk.0000228169.86845.29.CrossRefPubMed
36.
Via D, Kaufmann C, Anderson D, Stanton K, Rhee P: Effect of hydroxyethyl starch on coagulopathy in a swine model of hemorrhagic shock resuscitation. J Trauma. 2001, 50 (6): 1076-82. 10.1097/00005373-200106000-00016.CrossRefPubMed
37.
Haas T, Fries D, Holz C, Innerhofer P, Streif W, Klingler A, Hanke A, Velik-Salchner C: Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch solution. Anesth Analg. 2008, 106 (4): 1078-86. 10.1213/ane.0b013e318165df18.CrossRefPubMed
38.
Cho SD, Holcomb JB, Tieu BH, Englehart MS, Morris MS, Karahan ZA, Underwood SA, Muller PJ, Prince MD, Medina L, Sondeen J, Shults C, Duggan M, Tabbara M, Alam HB, Schreiber MA: Reproducibility of an animal model simulating complex combat-related injury in a multiple-institution format. Shock. 2009, 31 (1): 87-96. 10.1097/SHK.0b013e3181777ffb.CrossRefPubMed
39.
Martini WZ, Chinkes DI, Pusateri AE, Holcomb JB, Yu YM, Zhang XJ, Wolfe RR: Acute changes in fibrinogen metabolism and coagulation after hemorrhage in pigs. Am J Physiol Endocrinol Metab. 2005, 289: E930-E934. 10.1152/ajpendo.00137.2005.CrossRefPubMed
40.
Martini WZ, Holcomb JB: Acidosis and coagulopathy: the differential effects on fibrinogen synthesis and breakdown in pigs. Annals of Surgery. 2007, 246 (5): 831-835. 10.1097/SLA.0b013e3180cc2e94.CrossRefPubMed
41.
White TO, Clutton RE, Salter D, Swann D, Christie J, Robinson CM: The early response to major trauma and intramedullary nailing. Journal of Bone and Joint Surgery; British Volume. 2006, 88 (6): 823-827. 10.1302/0301-620X.88B6.17359.CrossRef
42.
Robinson CM, Ludlam CA, Ray DC, Swann DG, Christie J: The coagulative and cardiorespiratory responses to reamed intramedullary nailing of isolated fractures. Journal of Bone and Joint Surgery; British Volume. 2001, 83 (7): 963-973. 10.1302/0301-620X.83B7.11593.CrossRef
43.
Scalea TM, Holman M, Fuortes M, Baron BJ, Phillips TF, Goldstein AS, Sclafani SJ, Shaftan GW: Central venous blood oxygen saturation: an early, accurate measurement of volume during hemorrhage. J Trauma. 1988, 28 (6): 725-732. 10.1097/00005373-198806000-00001.CrossRefPubMed
44.
Mosnier LO, Griffin JH: Protein C anticoagulant activity in relation to anti-inflammatory and anti-apoptotic activities. Frontiers in Bioscience. 2006, 11: 2381-2399. 10.2741/1977.CrossRefPubMed
45.
Trzeciak S, Jones AE, Shapiro NI, Pusateri AE, Arnold RC, Rizzuto M, Arora T, Parrillo JE, Dellinger RP: A prospective multicenter cohort study of the association between global tissue hypoxia and coagulation abnormalities during early sepsis resuscitation. Critical Care Medicine. 2010, 38 (4): 1092-1100. 10.1097/CCM.0b013e3181cf6fbc.CrossRefPubMed
Metadata
Title
Systemic central venous oxygen saturation is associated with clot strength during traumatic hemorrhagic shock: A preclinical observational model
Authors
Nathan J White
Erika J Martin
Yongyun Shin
Donald F Brophy
Robert F Diegelmann
Kevin R Ward
Publication date
01-12-2010
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1757-7241-18-64

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