Administration of 25% albumin improves prehospital survivability in a preclinical rat model of decompensated hemorrhagic shock.

BACKGROUND: Plasma has been used as an efficient resuscitation fluid to improve prehospital survival from hemorrhagic shock. The 25% albumin (25% ALB, w/v in aqueous diluent) is a hyperoncotic fluid, and we hypothesize that it can be used as a lower-volume alternative to plasma in hypovolemic shock. METHOD: Isoflurane-anesthetized Sprague-Dawley rats were subjected to a lethal decompensated hemorrhagic shock via removing 65% estimated blood volume (EBV, calculated by 6% body weight (gram) + 0.77 mL) of blood within 20 min. At 20 min post-hemorrhage, rats randomly received plasma (20% EBV), 25% ALB (4% EBV), or respective vehicles, followed by fresh whole blood (FWB, 20% EBV) at 1 h post-hemorrhage. The outcome was also compared between plasma and 25% ALB without FWB resuscitation in a separate experiment. RESULTS: 20% EBV of plasma or 4% EBV of 25% ALB led to 100% survival at 60 min from the start of hemorrhage, compared to zero survival without treatment. Survival was maintained at least 4 h following limited resuscitation, with or without FWB at 1 h post-hemorrhage. The lack of fibrinogen in 25% ALB was notable and compromised the hemostatic outcome as compared to using plasma, which was partially restored by FWB resuscitation with the reduction in prothrombin time. CONCLUSION: The current study indicates that 25% ALB enhances survival and maintains hemodynamics at only one-fifth the volume of plasma. The results also suggest that 25% ALB requires hemostatic agents or subsequent blood products to counteract the hemostatic deficiency caused by hemodilution.