Packed Red Cell Age Associated With Adverse Cardiovascular Changes in an Ovine Model of Septic Shock Resuscitation

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Fanning, Jonathon P
Obonyo, Nchafatso G
Tung, John-Paul
Byrne, Liam
Simonova, Gabriela
Diab, Sara
Dunster, Kimble
Passmore, Margaret
Boon, Ai-Ching
Hoe, See Louise
Engkilde-Pedersen, Sanne
Esguerra-Lallen, Arlanna
Fauzi, Hashairi Mohd
Anstey, Christopher
et al.
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2018
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Chicago, Illinois, USA

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Abstract

Introduction: Packed red blood cell (PRBC) transfusion in septic shock is generally reserved as a last resort hemodynamic resuscitative measure or for haemoglobin less than 7.0 g/dL. Ex-vivo preservation and storage predispose PRBCs to biochemical / mechanical changes whose impact in a septic host is unknown. This randomised pre-clinical trial specifically evaluates select markers of cardiovascular stress in an ovine model of endotoxemic shock receiving either fresh or stored blood.

Methods: Twenty six anesthetised and mechanically ventilated merino ewes were randomly divided into endotoxemic shock (n = 16) or healthy (n = 10) groups. Endotoxemic shock was induced over 4 hours by infusing an escalating dose (total 11.25 mcg / kg) of lipopolysaccharide, LPS (E.coli 055:B5). During the last hour of LPS infusion, 10 mls / kg of either fresh, ≤ 5 days (n = 8) or stored, ≥ 30 days (n = 8) ovine packed PRBCs were administered. Healthy ewes received either fresh, ≤ 5 days (n = 5) or stored, ≥ 30 days (n = 5) ovine PRBCs at corresponding time points. Invasive haemodynamic monitoring and serial echocardiographic assessments were performed in all. Blood samples were measured for cardiac troponin I (cTnI), atrial natriuretic peptide (ANP) and hyaluronan at baseline (T0), 1, 3, 4, 5, 10 and 16h after which the ewes were euthanized.

Results: Stored versus fresh PRBCs produced raised hyaluronan levels (P < 0.001) from T3 onwards in both sepsis and healthy groups and resulted in significant (P < 0.001) adverse haemodynamic changes (cardiac index, central venous pressure, pulmonary artery pressure and mixed venous oxygen saturation). Elevated ANP was observed between T3 to T10 (P < 0.001) in septic compared to healthy ewes but there was no association with age of PRBCs. No statistical differences were observed between groups for TnI.

Conclusions: Sepsis and storage duration of PRBCs are associated with increased cardiovascular stress suggesting that stored PRBCs may predispose patients with septic shock to poor clinical outcomes.

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Circulation

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138

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Cardiovascular medicine and haematology

Clinical sciences

Sports science and exercise

Science & Technology

Life Sciences & Biomedicine

Cardiac & Cardiovascular Systems

Peripheral Vascular Disease

Cardiovascular System & Cardiology

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Fanning, JP; Obonyo, NG; Tung, J-P; Byrne, L; Simonova, G; Diab, S; Dunster, K; Passmore, M; Boon, A-C; Hoe, SL; Engkilde-Pedersen, S; Esguerra-Lallen, A; Fauzi, HM; Anstey, C; et al., Packed Red Cell Age Associated With Adverse Cardiovascular Changes in an Ovine Model of Septic Shock Resuscitation, Circulation, 2018, 138