Defining Dogma: Quantifying Crystalloid Hemodilution in a Prospective Randomized Control Trial with Blood Donation as a Model for Hemorrhage Samuel Wade.

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Presentation transcript:

Defining Dogma: Quantifying Crystalloid Hemodilution in a Prospective Randomized Control Trial with Blood Donation as a Model for Hemorrhage Samuel Wade Ross, MD, MPH, A. Britton Christmas, MD, FACS, Peter E. Fischer, MD, MS, FACS, Haley Holway, MD, Rachel Seymour, PhD, Ciara R. Huntington, MD, B. Todd Heniford, MD, FACS, Ronald F. Sing, DO, FACS, FCCM Journal of the American College of Surgeons Volume 227, Issue 3, Pages 321-331 (September 2018) DOI: 10.1016/j.jamcollsurg.2018.05.005 Copyright © 2018 American College of Surgeons Terms and Conditions

Figure 1 CONSORT flow diagram for patient accrual in the study and subsequent inclusion/exclusion and reasons. Eventually, 154 patients underwent analysis according to the group to which they were randomized. IVF, intravenous fluid. (Reprinted from Ross and colleagues11 with permission from Wolters Kluwer Health, Inc.) Journal of the American College of Surgeons 2018 227, 321-331DOI: (10.1016/j.jamcollsurg.2018.05.005) Copyright © 2018 American College of Surgeons Terms and Conditions

Figure 2 Hemoglobin levels by resuscitation group over time. *Indicates p < 0.001 for the global test and p < 0.0167 for pairwise testing between experimental and control groups. Journal of the American College of Surgeons 2018 227, 321-331DOI: (10.1016/j.jamcollsurg.2018.05.005) Copyright © 2018 American College of Surgeons Terms and Conditions

Figure 3 Hemodilution formula. Starting Hgb is the pre-donation hemoglobin in this study, or applied to surgical patients, is the preoperative hemoglobin, or applied to traumatic cases, could be estimated as the average hemoglobin for the person's age and sex. Blood loss coefficient, l = 5.111 g/dL; EBL, estimated blood loss; equilibration coefficient, h = 6.722 g/dL; resuscitation coefficient, r = 2.617 g/dL; TBV, total blood volume; VR, volume replacement. Journal of the American College of Surgeons 2018 227, 321-331DOI: (10.1016/j.jamcollsurg.2018.05.005) Copyright © 2018 American College of Surgeons Terms and Conditions

Figure 4 Sample calculated immediate hemodilution hemoglobin value, for immediately after blood loss, after equilibration, and resuscitation (hemodilution). X is volume in liters (L) for estimated blood loss (EBL) or VR (volume replacement) on the x-axis. EBL (square) or volume of resuscitation (triangle), or both (diamond) lines. Journal of the American College of Surgeons 2018 227, 321-331DOI: (10.1016/j.jamcollsurg.2018.05.005) Copyright © 2018 American College of Surgeons Terms and Conditions