Thromboelastographic analysis of novel polyethylene glycol based low volume resuscitation solutions

• Published in: PloS one Vol. 13; no. 11; p. e0207147
• Main Authors: Liebrecht, Loren K, Newton, Jason, Martin, Erika J, Wickramaratne, Nina, Jayaraman, Sudha, Han, Jinfeng, Aboutanos, Michel, Brophy, Donald F, Mangino, Martin J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.11.2018; Public Library of Science (PLoS)
• Subjects: Animal models; Biology and Life Sciences; Blood; Blood products; Coagulation; Dilution; Drug therapy; Fibrinolysis; Fluids; Hemorrhage; Hemorrhagic shock; Hydroxyethyl starch; Lactic acid; Medicine; Medicine and Health Sciences; Metabolism; Microvasculature; Patients; Perfusion; Pharmacy; Physical Sciences; Platelets; Polyethylene glycol; Polymers; Population (statistical); Propagation; Resuscitation; Rodents; Surgery; Trauma; United States > US; Virginia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0207147

Low volume resuscitation (LVR) in shock prevents deleterious effects of crystalloid loading in pre-hospital settings. Polyethylene glycol 20,000 (PEG-20k) based LVR solutions are 20-fold more effective at maintaining perfusion and survival in shock compared to conventional crystalloids. The aim of this study was to determine coagulation and platelet function of whole blood treated with 10% PEG-20k. Citrated blood from volunteers (n = 25) or early admission severely injured trauma patients (n = 9) were diluted 10% with various LVR solutions in a matched design with a paired volume control (saline), and studied using thromboelastography (TEG). In healthy volunteers and patients, 10% PEG-20k significantly increased clot amplification time (k), decreased propagation (angle), maximal clot size and strength (MA), and the overall coagulation index (CI), but not clot initiation (R) or fibrinolysis (Ly30), relative to paired saline dilutional controls. Clinically, K, angle, and MA were just outside of the normal limits in volunteers but not in patients. No statistical differences existed between PEG-20k and Hextend (HES) in either patient population. In a dose response series using volunteer blood, all effects of 10% PEG-20k on TEG were reversed and normalized by lower concentrations (7.5% and 5%). Furthermore, 7.5% PEG-20k produced similar resuscitation effects as 10% PEG in rodent hemorrhagic shock models (n = 5). In conclusion, PEG-20k based LVR solutions produced a dose-dependent minor hypocoagulative state, possibly associated with changes in clot propagation and platelet function, which can be reversed by dose reduction in concentration while providing superior LVR, microvascular rescue, and lactate clearance compared to saline or starch.