Comparison of Adsol and CPDA-1 blood preservatives during simulated massive resuscitation after hemorrhage in swine

BACKGROUND: In recent years, there has been a change from the use of blood stored in CPDA-1 to the use of red cells (RBCs) stored in electrolyte mixtures, such as Adsol (AS-l RBCs). However, because Adsol contains mannitol, as well as increased amounts of glucose relative to CPD and CPDA-1, concerns have been expressed as to possible harmful effects (recipient hyperglycemia, inappropriate osmotic diuresis) that it might induce under conditions of massive RBC transfusion. STUDY DESIGN AND METHODS: A hemorrhagic shock animal model was used to evaluate the effects of large-volume infusion of CPDA-1 or Adsol on glucose homeostasis and on urinary output under conditions that were devoid of extensive surgical manipulation. Hemorrhage was induced in 10 female Pitman-Moore mini-pigs to maintain mean arterial blood pressure at 55 mmHg for 90 minutes. After the return of autologous RBCs plus 1 L of 0.9-percent sodium chloride, the animals were given solution equivalent to the solute load in either 20 units of CPDA-1 whole blood (63 mt x 20 = 1260 mt) or 20 units of AS-I RBCs (100 mt x 20 = 2000 mt) over a period of 90 minutes. Animals were monitored to determine physiologic and blood chemical responses to infusion of the solutions and to determine if there was hyperglycemia or inappropriate diuresis in the Adsol-treated group. RESULTS: Animals that received CPDA-1 developed significant hypocalcemia, arterial hypotension, and elevated blood glucose concentrations; two of five animals died of circulatory collapse. In contrast, glucose metabolism in the Adsol recipients was well-regulated, serum ionized calcium concentration was not significantly altered, and all animals survived. No evidence of inappropriate diuresis was observed. CONCLUSION: Administration of large amounts of Adsol was not associated with hyperglycemia or inappropriate osmotic duiresis in hemorrhaged and resuscitated minipigs. These data suggest that fewer physiologic changes may be associated with the massive transfusion of AS-1 RBCs than with that of CPDA-1 whole blood.