Volume 80, Issue 12, Pages 1424-1430 (December 2009) Increased survival with hypotensive resuscitation in a rabbit model of uncontrolled hemorrhagic shock in pregnancy  Yan-hong Yu, Shi-peng Gong, Chao Sheng, Ke-seng Zhao, Robert F. Lodato, Chen-hong Wang  Resuscitation  Volume 80, Issue 12, Pages 1424-1430 (December 2009) DOI: 10.1016/j.resuscitation.2009.08.024 Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 Mean arterial pressure (MAP) vs. time for the six groups of pregnant rabbits undergoing hemorrhagic shock. See text for details. Values are mean±SD. N=10 per group. Hemorrhagic shock produced a marked decrease in MAP to 40mmHg and a marked increase in heart rate and respiratory rate at the end of the shock phase at 30min (T30). Volume resuscitation increased MAP to the respective target levels at T90. In the simulated hospital phase, MAP gradually increased for groups RE50, RE60, and RE70, but decreased for group RE80. Resuscitation decreased heart rate and respiratory rate but to a lesser degree in the RE80 group (T180). Groups: SS, sham shock; SH, shock without resuscitation; RE50, RE60, RE70, and RE80, shock with Ringer's solution resuscitation to a mean arterial pressure (MAP) of 50, 60, 70, and 80mmHg, respectively, during the simulated prehospital phase (T30 to T90). Symbols indicate statistically significant differences at P<0.05; *: SH vs. RE50, RE60, RE70, RE80. Resuscitation 2009 80, 1424-1430DOI: (10.1016/j.resuscitation.2009.08.024) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 Infused volume of Ringer's solution and blood transfusion volume for the four groups of pregnant rabbits exposed to hemorrhagic shock. See text and Fig. 1 legend for details. Infused volume of Ringer's solution increased with the increase in target MAP from 50 to 80mmHg (groups RE50, RE60, RE70, and RE80) for the simulated prehospital and hospital phases of the study. No significant difference was found between resuscitated groups in blood transfusion volume. Values of r2 and P are from linear regression analysis. Resuscitation 2009 80, 1424-1430DOI: (10.1016/j.resuscitation.2009.08.024) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 3 Intra-abdominal blood loss for the five groups of pregnant rabbits exposed to hemorrhagic shock. See text and Fig. 1 legend for details. Left panel: Intra-abdominal blood loss increased with the increase in target MAP from 50 to 80mmHg (groups RE50, RE60, RE70, and RE80) for the simulated prehospital phase of the study. Intra-abdominal blood loss in the resuscitated groups was significantly less than that in shock without resuscitation group (SH). Right panel: The volume of intra-abdominal blood loss was positively correlated with infused volume of Ringer's solution during the prehospital phase for the resuscitated groups of pregnant rabbits exposed to hemorrhagic shock. Resuscitation 2009 80, 1424-1430DOI: (10.1016/j.resuscitation.2009.08.024) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 4 Laboratory parameters at the end of simulated hospital phase of the study. See text and Fig. 1 legend for details. *P<0.05 vs. SH. #P<0.05 vs. RE60. For each plot, a U-shape pattern is apparent for the line connecting groups SH through RE80, suggesting an optimum resuscitation target at or near 60mmHg (group RE60). Resuscitation 2009 80, 1424-1430DOI: (10.1016/j.resuscitation.2009.08.024) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 5 Linear regression analysis for prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (Fbg) at the end of the simulated hospital phase. Left panels: PT, APTT were positively correlated and Fbg was negatively correlated with total infused volume of Ringer's solution for the resuscitated groups of pregnant rabbits exposed to hemorrhagic shock. Right panels: In contrast, no correlation was found between PT, APTT, Fbg and blood transfusion volume. See text and Fig. 1 legend for details. Resuscitation 2009 80, 1424-1430DOI: (10.1016/j.resuscitation.2009.08.024) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 6 Cumulative survival and median survival time for the four groups of pregnant rabbits undergoing hemorrhagic shock and resuscitation. See text and Fig. 1 legend for details. Median survival time was greatest for group RE60 (*P<0.05 vs. all other groups). All rabbits in the unresuscitated group, group SH, died within the first day (not shown). Resuscitation 2009 80, 1424-1430DOI: (10.1016/j.resuscitation.2009.08.024) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions