Low volume resuscitation with HBOCs in hemorrhagic shock

Abstract

Current management strategies for hemorrhaging trauma patients recommend fluid resuscitation with relatively small or restricted fluid volumes. Because most recommended fluids are essentially plasma expanders with limited oxygen carrying capacity, hemoglobin [Hb]-based oxygen-carrying compounds (HBOCs) have been suggested as an adjunct to improve oxygen delivery to the tissues. We review evidence from clinical to animal trials as to the efficacy of three competing low volume fluid resuscitation strategies (LVFR), and the potential in this context for HBOCs as oxygen therapeutic adjuncts. Unfortunately data are too limited in quantity and quality to allow any reliable conclusions as to the efficacy and safety of HBOC-augmented LVFR. There is an imperative need for higher quality and adequately-powered animal trials and clinical randomized controlled trials to clarify the efficacy and safety of both LVFR and adjunct HBOCs for traumatic hemorrhage.