Packed Red Cell Age Associated With Adverse Cardiovascular Changes in an Ovine Model of Septic Shock Resuscitation
File version
Author(s)
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.
Griffith University Author(s)
Primary Supervisor
Other Supervisors
Editor(s)
Date
Size
File type(s)
Location
Chicago, Illinois, USA
License
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.
Journal Title
Conference Title
Circulation
Book Title
Edition
Volume
138
Issue
Thesis Type
Degree Program
School
DOI
Patent number
Funder(s)
Grant identifier(s)
Rights Statement
Rights Statement
Item Access Status
Note
Access the data
Related item(s)
Subject
Cardiovascular medicine and haematology
Clinical sciences
Sports science and exercise
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Persistent link to this record
Citation
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