Resuscitation of hemorrhagic shock with hypertonic saline/dextran or lactated Ringer's supplemented with AICA riboside

J. P. Spiers, T. C. Fabian, K. A. Kudsk, K. G. Proctor

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25 Scopus citations


Anesthetized and ventilated swine were bled 23 ml/kg (34% of calculated blood volume) to a mean arterial pressure <50 mm Hg. After 60 min, a bolus of either 7.5% hypertonic saline/6% dextran 70 (HSD, 4 ml/kg x 5 min) or lactated Ringer's (LR, 32 ml/kg x 5 min) was infused i.v. LR (25-30 ml/kg) was administered to all animals for the next 60 min. Amino imidazole carboxamide riboside (AICAR), which increases endogenous adenosine in ischemic tissues, was added to the initial bolus and the subsequent LR (10 mg/kg bolus + 0.5 mg/kg x 60 min) in half the study population. At 2 hr post- shock, hematocrit, urine output, arterial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, portal venous O2 saturation, and pulmonary arterial O2 saturation were similar in all groups. With HSD vs. LR, cardiac outputs and stroke volumes were each significantly higher, while right atrial pressures and pulmonary vascular resistances were each significantly lower, which is consistent with augmented cardiac contractility with HSD. Furthermore, systemic oxygen consumptions were significantly higher, and intracranial pressures were each significantly lower with HSD. Nevertheless, no variables were far outside the normal range in either group. The addition of AICAR to LR and HSD eliminated the difference in intracranial pressure, systemic oxygen consumption, reduced heart rate by 30-40 beats/min during the first hour of resuscitation, and increased stroke volume by 20- 30%. Therefore 1) aggressive resuscitation of hemorrhagic shock with either HSD or LR can stabilize hemodynamics, but some variables were improved with HSD; 2) an AICAR supplement in HSD or LR eliminated some, but not all, of the hemodynamic differences between HSD and LR; 3) AICAR did not cause the hypotension or secondary tachycardia expected with an ATP or adenosine supplement. In context with other work, these data suggest that in many cases (e.g., the trauma patient without critical injuries), LR alone provides adequate resuscitation, and HSD might have no obvious benefit, other than a lower total fluid requirement. In other cases (e.g., head injury, the severely injured trauma patient), the salutary effects of HSD or AICAR could translate to a clinical improvement.

Original languageEnglish (US)
Pages (from-to)29-36
Number of pages8
JournalCirculatory Shock
Issue number1
StatePublished - 1993
Externally publishedYes


  • adenosine
  • amino imidazole carboxamide riboside
  • ATP
  • hemodynamics
  • ischemia/reperfusion injury
  • laser Doppler

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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