Increasing Plsama Transfusion Effect Lung Injury In Damage Control Resuscitation Of Hemorrhagic Shock

Increasing the ratio of fresh frozen plasma (FFP) to red blood cells (RBC) afterhaemorrhagic shock is beneficial in clinical situations utilising damage controlresuscitation (DCR). However, the present civilian clinical and military studies lackrandomised controlled trials to account for survivorship bias. In the present study, weadapted a rat haemorrhagic shock model to investigate the effects of transfusing variousratios of FFP: RBC and FFP compared to LR in rats subjected to HS, which is consistentwith the strategy of DCR.The rats were initially resuscitated with Ringer’s lactate (LR)using the same volume as used in blood withdrawal after a severe pressure-controlledhaemorrhage. The MAP for resuscitation groups was maintained at95~100mmHg for30min during the period of resuscitation with FFP: RBC during DCR. The animals weresubsequently observed for a short period. Myeloperoxidase (MPO) activity, inducible NOsynthase (iNOS) activity, wet/dry lung weight and nuclear factor κB (NF-κB) p65DNAbinding activity in the lungs was measured four hours after resuscitation. The levels oftumour necrosis factor (TNF)-α and macrophage inflammatory protein (MIP)-2in the lungwere also measured.The results show that the rats receiving resuscitation with a1:1ratio exhibiteddecreased concentrations of MIP-2and had mitigated lung oedema compared with otherresuscitation groups. Although not statistically significant, rats resuscitated with a1:1ratioof FFP: RBC displayed a trend of decreased NF-κB, iNOS, TNF-α levels in the lungcompared with all other resuscitation groups.Compared with LR1:1group, there weresignificant decreases in the levels of MDA, NF-κB,MIP-2, MPO activity and lung oedemain the1:1group.Our results indicated that resuscitation from HS with a1:1ratio of FFP to RBC isassociated with mitigated pulmonary oedema and decreased pulmonary inflammatoryresponse. Resuscitation from HS with a high ratio of FFP to RBC decreased thetransfusion volume of RBC. Furthermore, the use of FFP in resuscitation afterhaemorrhagic shock could decrease the expression of MIP-2and mitigate pulmonaryoedema compared LR. Based on these data, we confirm that the1:1ratio of FFP to RBCshould be beneficial in clinical situations associated with haemorrhagic shock/resuscitation.