Unexpected 100% Survival Following 60% Blood Loss Using Small-Volume 7.5% NaCl With Adenocaine and Mg2+ in the Rat Model of Extreme Hemorrhagic Shock

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Hemorrhage is responsible for up to 40% of trauma mortality, and of these deaths, 33% to 56% occur during the prehospital period. In an effort to translate the cardioprotective effects of Adenocaine (adenosine, lidocaine) and Mg2+ (ALM) from cardiac surgery to resuscitation science, we examined the early resuscitative effects of 7.5% NaCl with ALM in the rat model of 60% blood loss. Male Sprague-Dawley rats (250–350 g, n = 40) were anesthetized and randomly assigned to one of five groups: (a) untreated, (b) 7.5% NaCl, (c) 7.5% NaCl/6% dextran 70, (d) 7.5% NaCl/Mg2+, and (e) 7.5% NaCl/ALM. Blood withdrawal occurred over ∼50 min (MAP 30–35 mmHg), and rats were left in shock for 30 min. Total shock time was ∼80 min; 0.3-mL bolus was injected intravenously over 10 s, and hemodynamics monitored for 60 min (phase 1). Shed blood was reinfused and function monitored for a further 60 min (phase 2). Lead II electrocardiogram, arterial pressures, mean arterial pressure (MAP), pulse pressure (PP), heart rate (HR), and rate-pressure product were monitored. Mortality was as follows: untreated (100%), 7.5% NaCl (75%), 7.5% NaCl/6% dextran 70 (87.5%), 7.5% NaCl/Mg2+ (62.5%), and 7.5% NaCl/ALM (0%). Deaths occurred at different times depending on treatment group and paralleled differences in the total number of ventricular arrhythmias with the highest number in untreated animals (49 ± 17) and lowest in 7.5% NaCl/ALM rats (2 ± 1.8) (P < 0.05). At the end of phase 1, MAP of 7.5% NaCl/ALM–treated animals increased from 29 to 40 mmHg (P < 0.05). At the end of phase 2, MAP, PP, HR, and rate-pressure product in the ALM group were 75%, 193%, 96%, and 83% of their preshock values. Small-volume (∼1 mL/kg) i.v. bolus of 7.5% NaCl/ALM led to 100% survival following 60% blood loss with higher MAP than any group, an 89% to 96% reduction in the total number of arrhythmias, and a stable HR.

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