The effects of small-volume hypertonic saline and large-volume lactated Ringer's solutions on intra-abdominal blood loss after spleen rupture or iliac artery tear

Introduction

Prehospital fluid resuscitation, before hemorrhage control, of hypotensive trauma victims sustaining blunt or penetrating abdominal trauma is highly controversial, largely due to concerns related to increased blood loss or rebleeding.

Objective

In two separate studies, simulating blunt or penetrating abdominal trauma, we tested the hypothesis that prehospital fluid resuscitation could provide hemodynamic benefits despite increased intra-abdominal bleeding, which was directly measured after a spleen rupture or an iliac artery tear.

Methods

Anesthetized dogs (17 ± 2 kg) were submitted to two distinct models of uncontrolled intra-abdominal hemorrhage. Suture lines were placed either around the spleen or through the left common iliac artery, and exteriorized. After abdominal closure, splenic rupture with hilar vascular injury (SR, n = 30) or a 3-mm iliac arterial tear (IAT, n = 18) was produced by pulling the exteriorized line, and animals were randomized into three groups 20 min later: lactated Ringer's (LR), 32 ml/kg over 15 min; 7.5% NaCl/6% Dextran70 (HSD), 4 ml/kg over 4 min; or controls (CT), no fluids.

Results

Both HSD and LR treatments restored cardiac output, while in controls it remained reduced. No significant differences occurred in blood loss (ml/kg) between CT and treated animals after IAT (CT 48 ± 6; HSD 42 ± 2; LR 49 ± 1), or SR (CT 38 ± 4; HSD 43 ± 5; LR 42 ± 5).

Conclusion

No fluid infusion during intra-abdominal bleeding resulted in a low blood flow state, while resuscitation with both HSD and LR produced hemodynamic benefits without increased blood loss.