Potassium kinetics in hemorrhagic shock: immediate effects of packed red blood cell transfusion

• Grant number: 10/11883-2
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: October 01, 2010
• End date: September 30, 2011
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Joel Avancini Rocha Filho
• Grantee: Alan Saito Ramalho
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Hemorrhagic shock (HS) remains a major cause of early death after trauma. HS patients are exposed to pathophysiologic processes and therapeutic interventions, mainly blood transfusion, that predispose to hyperkalemia (hyperK), one of the deadliest electrolyte abnormalities. HyperK unrelated accompanies the onset of HS and correlates with the severity of hypoperfusion and early animal mortality. There are several reports describing packed red blood cells (PRBC) related hyperkalemic cardiac arrest. PRBC K concentration is directly proportional to storage time, easily reaching levels higher than 60 mEq/L after 21 days. Our hypothesis is that 21 days-stored PRBC administration during HS is associated with critical increases in serum K and cardiac arrest when compared with washed PRBC or short-storage PRBC infusion. Methods: 24 male pigs healthy will be studied in a model of lethal HS through femoral artery controlled bleeding. The animals will be randomized to receive one of the 3 PRBC tested: Group 1 - 21 days-storage PRBC; Group 2 - 21 days-storage washed PRBC; Group 3 - 2-5 days-storage PRBC. The animals will be studied in 15 different moments and the variables analyzed will be: gasometrical analysis from animals and PRBC; biochemical analysis from animals and PRBC; free hemoglobin and haptoglobin levels; hemodynamic analysis; serum TNF±, IL-6 e IL-10 levels; mortality.