失血性休克是具有高死亡率的具有临床挑战性的疾病过程。当常规血液制品不能给药时,有时会使用携带氧气的血液替代品。这种情况的国际经验是有限的。我们的目标是增加这一系列的文学。
这是一例病例报告,对患有产后出血和出血性休克的患者服用牛血红蛋白基载氧红细胞(RBC)替代品HBOC-201(HemoPure®),因为该患者拒绝输注RBC。HBOC-201是在食品和药物管理局一次性紧急研究新药(eIND)批准的同意下进行的,并获得机构审查委员会的适当通知。
患者因失血性休克用HBOC-201成功复苏。她断奶了血管加压药支持,并在4小时内恢复了基线精神状态。然而,大约36小时后,患者出现多器官系统功能障碍,体积过载,右心衰竭,最终在产后第4天提前过期。
用HBOC-201作为红细胞替代方案从失血性休克复苏是可行的,但是,在长期低流量造成的后遗症的管理方面仍然存在重大挑战,大量输注无细胞胶体载氧体后,缺血状态以及明显的胶体压力和容量超负荷。
Hemorrhagic shock is a clinically challenging disease process with high mortality. When conventional blood products are unable to be administered, oxygen-carrying blood alternatives are sometimes utilized. The international experience with this scenario is limited. We aim to add to this body of literature.
This is a
case report of the administration of bovine hemoglobin-based oxygen-carrying red blood cell (RBC) substitute HBOC-201 (HemoPure®) to a patient with post-partum bleeding and hemorrhagic shock because the patient declined RBC transfusion. HBOC-201 was administered with consent under a one-time Emergency Investigational New Drug (eIND) approval from the Food and Drug Administration with appropriate notification of the Institutional Review Board.
The patient was successfully resuscitated with HBOC-201 from hemorrhagic shock. She was weaned off of vasopressor support and extubated with the recovery of her baseline mental status within 4 h. However, approximately 36 h after this, the patient developed multi-organ system dysfunction, volume overload, right heart failure and ultimately expired early on post-partum day 4.
Resuscitation from hemorrhagic shock with HBOC-201 as an RBC alternative is feasible, but significant challenges remain with the management of sequelae resulting from prolonged low-flow, ischemic states as well as the significant colloid pressure and volume overload experienced after massive transfusion with an acellular colloid oxygen carrier.