Noam Gavriely1,2*, Sharon Abadi-Saar2, Efrat Gavriely2, Larry R Murdock2 and Jukka O Rasanen3
1Department of Physiology and Biophysics (ret.), Technion – Israel Institute of Technology, Israel
2Oneg HaKarmel Ltd. Tirat Carmel, Israel
3Mayo Clinic (Emer.), Rochester, MN, USA
Submission: January 28, 2025; Published: February 07, 2025
*Corresponding author: Noam Gavriely, 11 Sinai Ave. Haifa, Israel 3433114
Abstract
Restoring core blood volume is key to survival in severe haemorrhagic shock (SHS). Matching blood volume to vascular volume facilitates venous return to the heart, adequate cardiac output, blood pressure and perfusion of the essential organs. This is a review of the available practical options of doing so in the pre-hospital and in-hospital settings. We evaluate critically the use of blood products transfusion; pneumatic antishock garment (PASG), auto-transfusion tourniquet (A-TT) and pharmaceutical vasoconstrictors.
Introduction
Severe haemorrhagic shock (SHS) is the cause of death of nearly 2 million persons each year. Seventy eight percent of these cases are due to trauma and the balance are caused by ruptured aneurysms (10.2%), gastro-intestinal bleeding (7.5%) and pregnancy-related haemorrhages (3.7%) [1]. About a third of patients who suffer SHS die before they make it to the hospital and about 10% more die in the first 24 hours in the hospital. The concept of the “Golden Hour” has been shown by A Q Alarhayem, et Al to be incorrect [2]. They stated that “…future efforts should be directed toward the development of therapies to increase the window of survival in the prehospital environment.”, particularly when evacuation and transport times are longer than 30 minutes. In this review we compare the pros and cons of methods that can be used to restore core blood volume in pre-hospital SHS.
Core blood volume restoration in SHS aims to keep systolic blood pressure above 90 mmHg, to keep heart rate below 120 beats per minute and to maintain the patient alert in the absence of head trauma and/or mental functions altering drugs. The goals of therapy are also common to all methods. They are to keep sufficient perfusion of the vital tissues (heart, brain, viscera, kidneys). Minute-to-minute monitoring of the SHS patient is commonly done by repeated measurements of vital signs: blood pressure, heart rate, SPO2 and if the patient is intubated – end-tidal PCO2. These parameters are useful but can miss deficiencies of tissue perfusion. As such, monitoring of lactate and urine output are also done to assess the extent of shock.