Aug
2001

Diaspirin cross-linked hemoglobin fails to improve left ventricular diastolic function after fluid resuscitation from hemorrhagic shock.

Pape A, Kemming G, Meisner F, Kleen M, Habler O
Eur Surg Res 2001;33(5-6):318-326.
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In this article, Pape et al. present the effects on left ventricular diastolic function of fluid resuscitation with DCLHb in domestic pigs submitted to hemorrhagic shock after the creation of a critical left anterior descending coronary artery stenosis. The main results had been published previously: all 10 animals resuscitated with DCLHb survived while 5 out of 10 resuscitated with human albumin died. Despite these positive results, LV diastolic function actually deteriorated after resuscitation with DCLHb. In their previous article, the authors had reported that myocardial oxygenation improved, probably explaining the improvement in survival. Therefore other factors, possibly related to preload and afterload, must be set forth to explain the deleterious effect of DCLHb on LV diastolic relaxation.
Once again, the rationale underlying the use of hemoglobin solutions is simple and intuitively attractive. However, the clinical reality is much more complex and these molecules produce several, often competing, effects. Despite the limitations inherent to a laboratory investigation, the reader should remember that this is one of the few experiments showing an improved survival with a hemoglobin solution in the context of hemorrhagic shock and jeopardized myocardial perfusion.

– J.-F. Hardy