Oxygen Consumption Changes with Stored Blood Infusions JUDY T. OMAN-McDANAL, M.D.,* GREGORY T. SMITH, B.S., GLENN T. SUEHIRO, B.S., SAMUEL SIMS, B.S., J. JUDSON McNAMARA, M.D.t
Stored blood contains microaggregates, often implicated in the From The Queen's Medical Center, Honolulu, Hawaii pathogenesis of post-traumatic pulmonary insufficiency. This study was an attempt to further elucidate the effect of autologous stored, filtered and non-filtered blood infusions and homologous The present study was undertaken to evaluate the efstored and fresh blood infusions on pulmonary function fect of stored autologous baboon blood with and without and hemodynamics. Inconsistent changes in pulmonary hemodynamics and blood oxygenation were noted. The one sig- ultrafiltration and stored and fresh homologous baboon nificant finding was an increase in oxygen consumption, which blood without ultrafiltration on pulmonary function and occurred with unfiltered autologous or homologous blood but not pulmonary and systemic hemodynamics. with fresh or filtered blood. Since an increased oxygen consumption results in an oxygen demand which is difficult to meet in the Materials and Methods face of multiple other injuries, it is conceivable that this observation implicates massive stored blood transfusion as a major conFifteen baboons (Papio Anubis), 5-10 kg, were bled tributing factor in the development of so-called irreversible 35cc/Kg and the blood was stored at 4C in CPD solution shock.
BANKED BLOOD, collected in ACD or CPD solution, and stored at 4C, has been shown to develop significant amounts of microaggregates. These microaggregates, often termed "debris," are composed of platelets, white blood cells, and fibrin.1222 The amount of debris increases with storage time, and is initially composed of platelets, followed later by accumulation of fibrin onto the platelets.' This debris in stored blood has been found to produce changes in pulmonary hemodynamics in animals4'7 9 and has been implicated in the pathogenesis of post-traumatic pulmonary insufficiency in man. 8'1113'14'17'18,20 Ultrafiltration of stored blood with newly designed small pore filters will remove the mi-
croaggregates.6'10'15"9 Submitted for publication March 1, 1975. *Cardiovascular Research Fellow, The Queen's Medical Center, Honolulu, Hawaii. tDirector of Surgical Education, The Queen's Medical Center, Professor of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii. Reprint requests: Judy T. Oman-McDanal, M.D., Cardiovascular Research Department, The Queen's Medical Center, 1301 Punchbowl Street, Honolulu, Hawaii 96813.
in plastic bags. Three weeks later, the animals were anesthetized with phencyclidine hydrochloride (Sernylan) as an induction agent and with sodium thiopental (Pentothal) as a maintenance agent. They were intubated and connected to a volume respirator (Harvard Apparatus Co., Millis, Mass.). Using sterile surgical technique, a thoracotomy was performed and catheters were placed in the pulmonary artery and left atrium. A flow probe was placed around the pulmonary artery and a femoral catheter was inserted. The flowmeter and probe were previously calibrated using excised arterial segments and whole blood. The flow probe was monitored through a BL-610 pulse logic flowmeter (Biotronex Laboratory, Inc., Silver Spring, Md.). The catheters in the pulmonary artery and left atrium were connected to Stratham pressure transducers (Model 23AA and 23BB, Hato Rey, Puerto Rico). A Brush 260 recorder (Gould Inc., Cleveland, Ohio) was used to record the electrocardiogram, pressures, and pulmonary artery flow. A rectal catheter and bladder catheter were used to measure body temperature and urine output respectively. When the animal was stabilized, baseline values for pressures, blood gases and cardiac output were measured. Studies were repeated after 15 minutes on 100o
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oxygen. All measurements were made in quadruplicate. The animal then underwent an exchange blood infusion with either autologous 21-day stored blood (35cc/kg), homologous 21-day stored blood (80cc/kg), homologous fresh blood (80cc/kg) or autologous 21-day old blood infused through a Swank in-line blood filter (35cc/kg). Studies were then obtained 15 minutes after infusion while the animals were still breathing 100% oxygen. The oxygen was then discontinued, the animal placed on room air and studies obtained after 15 minutes. Studies obtained were: blood hemoglobin concentration, arterial blood gases, venous blood gases, left atrial pressure (LAP), pulmonary artery pressure (PAP) and femoral artery pressure (FAP). Blood gas determinations were done on an Instrumentation Laboratory BloodGas/pH Analyzer (Model 113, Instrumentation Laboratories, Inc., Lexington, Mass.). All PoQ determinations were standardized to pH 7.40 by means of the pH coefficient of -0.500 derived by Astrup's group2 and shown in the equation: Corrected Pa2 (7.40) = (-0.500[7.40-obs. Observed PQ (pH) Hemoglobin concentration and oxygen saturation were measured with an Instrumentation Laboratory Model 182 Co-oximeter. The oxygen consumption was determined by the Fick Method. Pulmonary Vascular Resistance was calculated by: COLAP x 80 x 60 and expressed in dynessec-cm-5. Animals were maintained at normothermia and pH])
10
105
no temperature corrections were made. Data analyzed using the Student t-test.
were
Results All animals receiving stored, unfiltered blood, either autologous (Group A) or homologous (Group B) showed a significant (P
Stored blood contains microaggregates, often implicated in the From The Queen's Medical Center, Honolulu, Hawaii pathogenesis of post-traumatic pulmonary insufficiency. This study was an attempt to further elucidate the effect of autologous stored, filtered and non-filtered blood infusions and homologous The present study was undertaken to evaluate the efstored and fresh blood infusions on pulmonary function fect of stored autologous baboon blood with and without and hemodynamics. Inconsistent changes in pulmonary hemodynamics and blood oxygenation were noted. The one sig- ultrafiltration and stored and fresh homologous baboon nificant finding was an increase in oxygen consumption, which blood without ultrafiltration on pulmonary function and occurred with unfiltered autologous or homologous blood but not pulmonary and systemic hemodynamics. with fresh or filtered blood. Since an increased oxygen consumption results in an oxygen demand which is difficult to meet in the Materials and Methods face of multiple other injuries, it is conceivable that this observation implicates massive stored blood transfusion as a major conFifteen baboons (Papio Anubis), 5-10 kg, were bled tributing factor in the development of so-called irreversible 35cc/Kg and the blood was stored at 4C in CPD solution shock.
BANKED BLOOD, collected in ACD or CPD solution, and stored at 4C, has been shown to develop significant amounts of microaggregates. These microaggregates, often termed "debris," are composed of platelets, white blood cells, and fibrin.1222 The amount of debris increases with storage time, and is initially composed of platelets, followed later by accumulation of fibrin onto the platelets.' This debris in stored blood has been found to produce changes in pulmonary hemodynamics in animals4'7 9 and has been implicated in the pathogenesis of post-traumatic pulmonary insufficiency in man. 8'1113'14'17'18,20 Ultrafiltration of stored blood with newly designed small pore filters will remove the mi-
croaggregates.6'10'15"9 Submitted for publication March 1, 1975. *Cardiovascular Research Fellow, The Queen's Medical Center, Honolulu, Hawaii. tDirector of Surgical Education, The Queen's Medical Center, Professor of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii. Reprint requests: Judy T. Oman-McDanal, M.D., Cardiovascular Research Department, The Queen's Medical Center, 1301 Punchbowl Street, Honolulu, Hawaii 96813.
in plastic bags. Three weeks later, the animals were anesthetized with phencyclidine hydrochloride (Sernylan) as an induction agent and with sodium thiopental (Pentothal) as a maintenance agent. They were intubated and connected to a volume respirator (Harvard Apparatus Co., Millis, Mass.). Using sterile surgical technique, a thoracotomy was performed and catheters were placed in the pulmonary artery and left atrium. A flow probe was placed around the pulmonary artery and a femoral catheter was inserted. The flowmeter and probe were previously calibrated using excised arterial segments and whole blood. The flow probe was monitored through a BL-610 pulse logic flowmeter (Biotronex Laboratory, Inc., Silver Spring, Md.). The catheters in the pulmonary artery and left atrium were connected to Stratham pressure transducers (Model 23AA and 23BB, Hato Rey, Puerto Rico). A Brush 260 recorder (Gould Inc., Cleveland, Ohio) was used to record the electrocardiogram, pressures, and pulmonary artery flow. A rectal catheter and bladder catheter were used to measure body temperature and urine output respectively. When the animal was stabilized, baseline values for pressures, blood gases and cardiac output were measured. Studies were repeated after 15 minutes on 100o
104
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STORED BLOOD INFUSIONS
oxygen. All measurements were made in quadruplicate. The animal then underwent an exchange blood infusion with either autologous 21-day stored blood (35cc/kg), homologous 21-day stored blood (80cc/kg), homologous fresh blood (80cc/kg) or autologous 21-day old blood infused through a Swank in-line blood filter (35cc/kg). Studies were then obtained 15 minutes after infusion while the animals were still breathing 100% oxygen. The oxygen was then discontinued, the animal placed on room air and studies obtained after 15 minutes. Studies obtained were: blood hemoglobin concentration, arterial blood gases, venous blood gases, left atrial pressure (LAP), pulmonary artery pressure (PAP) and femoral artery pressure (FAP). Blood gas determinations were done on an Instrumentation Laboratory BloodGas/pH Analyzer (Model 113, Instrumentation Laboratories, Inc., Lexington, Mass.). All PoQ determinations were standardized to pH 7.40 by means of the pH coefficient of -0.500 derived by Astrup's group2 and shown in the equation: Corrected Pa2 (7.40) = (-0.500[7.40-obs. Observed PQ (pH) Hemoglobin concentration and oxygen saturation were measured with an Instrumentation Laboratory Model 182 Co-oximeter. The oxygen consumption was determined by the Fick Method. Pulmonary Vascular Resistance was calculated by: COLAP x 80 x 60 and expressed in dynessec-cm-5. Animals were maintained at normothermia and pH])
10
105
no temperature corrections were made. Data analyzed using the Student t-test.
were
Results All animals receiving stored, unfiltered blood, either autologous (Group A) or homologous (Group B) showed a significant (P
