Simone E Dekker1, Martin Sillesen2, Ted Bambakidis3, Guang Jin3, Baoling Liu3, Christa Boer4, Pär I Johansson5, Ihab Halaweish3, Jake Maxwell3, Hasan B Alam6. 1. Department of Surgery, University of Michigan Hospital, Ann Arbor, MI; Department of Anesthesiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands. 2. Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA; Department of Surgery, Copenhagen University Hospital, Hillerød, Denmark. 3. Department of Surgery, University of Michigan Hospital, Ann Arbor, MI. 4. Department of Anesthesiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands. 5. Capital Region Blood Bank, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Surgery, Centre for Translational Injury Research (CeTIR), University of Texas Medical School, Houston, TX. 6. Department of Surgery, University of Michigan Hospital, Ann Arbor, MI. Electronic address: alamh@med.umich.edu.
Abstract
BACKGROUND: Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of trauma-related deaths. These insults disrupt coagulation and endothelial systems. This study investigated whether previously reported differences in lesion size and brain swelling during normal saline (NS), colloids (Hextend [HEX]), and fresh frozen plasma (FFP) resuscitation are associated with differential effects on coagulation and endothelial systems. METHODS: We subjected 15 Yorkshire swine to TBI and HS (40% blood volume), and kept in HS for 2 hours before resuscitation with NS, HEX, or FFP. Markers of endothelial activation (E-selectin, Intercellular adhesion molecule [ICAM]-1), coagulation activation (prothrombin fragment 1 + 2), and natural anticoagulation (activated protein C [aPC]) were determined in serum and brain whole cell lysates. RESULTS: Serum levels of aPC were greater in the NS group (203 ± 30 pg/mL) compared with HEX (77 ± 28 pg/mL; P = .02) and FFP (110 ± 28 pg/mL; P = .09), as was PF 1 + 2 in the brain when compared with FFP (PF 1 + 2, 89 ± 46 vs 37 ± 14 ng/mL; P = .035). Brain E-selectin was greater in the NS group compared with FFP (3.36 ± 0.02 vs 3.31 ± 0.01 ng/mL; P = .029). Circulating ICAM-1 levels were increased in the NS group (151 ± 9 ng/mL) compared with the HEX (100 ± 9 ng/mL; P < .01) and FFP (108 ± 9 ng/mL; P = .01). CONCLUSION: In this clinically realistic large animal model of TBI + HS, NS resuscitation was associated with an early activation of coagulation, natural anticoagulation, and endothelial systems, compared with HEX and FFP.
BACKGROUND:Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of trauma-related deaths. These insults disrupt coagulation and endothelial systems. This study investigated whether previously reported differences in lesion size and brain swelling during normal saline (NS), colloids (Hextend [HEX]), and fresh frozen plasma (FFP) resuscitation are associated with differential effects on coagulation and endothelial systems. METHODS: We subjected 15 Yorkshire swine to TBI and HS (40% blood volume), and kept in HS for 2 hours before resuscitation with NS, HEX, or FFP. Markers of endothelial activation (E-selectin, Intercellular adhesion molecule [ICAM]-1), coagulation activation (prothrombin fragment 1 + 2), and natural anticoagulation (activated protein C [aPC]) were determined in serum and brain whole cell lysates. RESULTS: Serum levels of aPC were greater in the NS group (203 ± 30 pg/mL) compared with HEX (77 ± 28 pg/mL; P = .02) and FFP (110 ± 28 pg/mL; P = .09), as was PF 1 + 2 in the brain when compared with FFP (PF 1 + 2, 89 ± 46 vs 37 ± 14 ng/mL; P = .035). Brain E-selectin was greater in the NS group compared with FFP (3.36 ± 0.02 vs 3.31 ± 0.01 ng/mL; P = .029). Circulating ICAM-1 levels were increased in the NS group (151 ± 9 ng/mL) compared with the HEX (100 ± 9 ng/mL; P < .01) and FFP (108 ± 9 ng/mL; P = .01). CONCLUSION: In this clinically realistic large animal model of TBI + HS, NS resuscitation was associated with an early activation of coagulation, natural anticoagulation, and endothelial systems, compared with HEX and FFP.
Authors: Aaron M Williams; Umar F Bhatti; Isabel S Dennahy; Kiril Chtraklin; Panpan Chang; Nathan J Graham; Basil M Baccouche; Shalini Roy; Mohammed Harajli; Jing Zhou; Vahagn C Nikolian; Qiufang Deng; Yuzi Tian; Baoling Liu; Yongqing Li; Gregory L Hays; Julia L Hays; Hasan B Alam Journal: J Vis Exp Date: 2018-08-24 Impact factor: 1.355
Authors: Simone E Dekker; Vahagn C Nikolian; Martin Sillesen; Ted Bambakidis; Patrick Schober; Hasan B Alam Journal: J Neurosci Res Date: 2017-07-25 Impact factor: 4.164
Authors: Andrew R Mayer; Andrew B Dodd; Meghan S Vermillion; David D Stephenson; Irshad H Chaudry; Denis E Bragin; Andrew P Gigliotti; Rebecca J Dodd; Benjamin C Wasserott; Priyank Shukla; Rachel Kinsler; Sheila M Alonzo Journal: Neurosci Biobehav Rev Date: 2019-06-27 Impact factor: 8.989