Civilian traumatic brain injury (TBI) guidelines recommend resuscitation of patients with hypotensive TBI with crystalloids. Increasing evidence, however, suggests that whole blood (WB) resuscitation may improve physiological and survival outcomes at lower resuscitation volumes, and potentially at a lower mean arterial blood pressure (MAP), than crystalloid after TBI and hemorrhagic shock (HS). The objective of this study was to assess whether WB resuscitation with two different MAP targets improved behavioral and histological outcomes compared with lactated Ringer's (LR) in a mouse model of TBI+HS. Anesthetized mice (n = 40) underwent controlled cortical impact (CCI) followed by HS (MAP = 25–27 mm Hg; 25 min) and were randomized to five groups for a 90 min resuscitation: LR with MAP target of 70 mm Hg (LR₇₀), LR₆₀, WB₇₀, WB₆₀, and monitored sham. Mice received a 20 mL/kg bolus of LR or autologous WB followed by LR boluses (10 mL/kg) every 5 min for MAP below target. Shed blood was reinfused after 90 min. Morris Water Maze testing was performed on days 14–20 post-injury. Mice were euthanized (21 d) to assess contusion and total brain volumes. Latency to find the hidden platform was greater versus sham for LR₆₀ (p < 0.002) and WB₇₀ (p < 0.007) but not LR₇₀ or WB₆₀. The WB resuscitation did not reduce contusion volume or brain tissue loss. The WB targeting a MAP of 60 mm Hg did not compromise function versus a 70 mm Hg target after CCI+HS, but further reduced fluid requirements (p < 0.03). Using LR, higher achieved MAP was associated with better behavioral performance (rho = -0.67, p = 0.028). Use of WB may allow lower MAP targets without compromising functional outcome, which could facilitate pre-hospital TBI resuscitation.

中文翻译：

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全血与乳酸林格氏复苏的选择改变了小鼠脑外伤加失血性休克后血压目标与功能结果之间的关系

民间创伤性脑损伤 (TBI) 指南建议使用晶体液对低血压 TBI 患者进行复苏。然而，越来越多的证据表明，与 TBI 和失血性休克 (HS) 后的晶体相比，全血 (WB) 复苏可以在较低的复苏量和可能较低的平均动脉血压 (MAP) 下改善生理和生存结果。本研究的目的是评估在 TBI+HS 小鼠模型中，与乳酸林格氏 (LR) 相比，采用两种不同 MAP 目标的 WB 复苏是否可以改善行为和组织学结果。麻醉小鼠 ( n  = 40) 接受受控皮质冲击 (CCI)，然后接受 HS（MAP = 25–27 mm Hg；25 分钟），并随机分为五组，进行 90 分钟的复苏：LR 组，MAP 目标为 70 mm Hg（ LR ₇₀ )、LR ₆₀、WB ₇₀、WB ₆₀和监测假手术。小鼠接受 20 mL/kg 的 LR 或自体 WB 推注，然后每 5 分钟接受一次 LR 推注 (10 mL/kg)，以使 MAP 低于目标值。90分钟后将流出的血液回输。莫里斯水迷宫测试在受伤后 14-20 天进行。将小鼠安乐死（21天）以评估挫伤和总脑体积。_{对于 LR 60} ( p  < 0.002) 和 WB ₇₀ ( p  < 0.007)，找到隐藏平台的延迟比假手术更大，但 LR ₇₀或 WB ₆₀则不然。WB复苏并没有减少挫伤体积或脑组织损失。与 CCI+HS 后 70 mm Hg 目标相比，以 60 mm Hg MAP 为目标的 WB 并未损害功能，但进一步减少了液体需求 ( p < 0.03)。使用 LR，获得的 MAP 越高，行为表现越好（rho = -0.67，p =  0.028）。使用 WB 可以在不影响功能结果的情况下降低 MAP 目标，这可以促进院前 TBI 复苏。