1
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Pusateri AE, Morgan CG, Neidert LE, Tiller MM, Glaser JJ, Weiskopf RB, Ebrahim I, Stassen W, Rambharose S, Mahoney SH, Wallis LA, Hollis EM, Delong GT, Cardin S. Safety of Bioplasma FDP and Hemopure in rhesus macaques after 30% hemorrhage. Trauma Surg Acute Care Open 2024; 9:e001147. [PMID: 38196929 PMCID: PMC10773430 DOI: 10.1136/tsaco-2023-001147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/03/2023] [Indexed: 01/11/2024] Open
Abstract
Objectives Prehospital transfusion can be life-saving when transport is delayed but conventional plasma, red cells, and whole blood are often unavailable out of hospital. Shelf-stable products are needed as a temporary bridge to in-hospital transfusion. Bioplasma FDP (freeze-dried plasma) and Hemopure (hemoglobin-based oxygen carrier; HBOC) are products with potential for prehospital use. In vivo use of these products together has not been reported. This study assessed the safety of intravenous administration of HBOC+FDP, relative to normal saline (NS), in rhesus macaques (RM). Methods After 30% blood volume removal and 30 minutes in shock, animals were resuscitated with either NS or two units (RM size adjusted) each of HBOC+FDP during 60 minutes. Sequential blood samples were collected. After neurological assessment, animals were killed at 24 hours and tissues collected for histopathology. Results Due to a shortage of RM during the COVID-19 pandemic, the study was stopped after nine animals (HBOC+FDP, seven; NS, two). All animals displayed physiologic and tissue changes consistent with hemorrhagic shock and recovered normally. There was no pattern of cardiovascular, blood gas, metabolic, coagulation, histologic, or neurological changes suggestive of risk associated with HBOC+FDP. Conclusion There was no evidence of harm associated with the combined use of Hemopure and Bioplasma FDP. No differences were noted between groups in safety-related cardiovascular, pulmonary, renal or other organ or metabolic parameters. Hemostasis and thrombosis-related parameters were consistent with expected responses to hemorrhagic shock and did not differ between groups. All animals survived normally with intact neurological function. Level of evidence Not applicable.
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Affiliation(s)
| | - Clifford G Morgan
- Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
| | - Leslie E Neidert
- Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
| | - Michael M Tiller
- Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Jacob J Glaser
- Providence Regional Medical Center, Everett, Washington, USA
| | - Richard B Weiskopf
- Department of Anesthesia and Perioperative Medcine, University of California San Francisco, San Francisco, California, USA
| | - Ismaeel Ebrahim
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Willem Stassen
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Sanjeev Rambharose
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Scott H Mahoney
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Lee A Wallis
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Ewell M Hollis
- Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
| | - Gerald T Delong
- Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
| | - Sylvain Cardin
- Naval Medical Research Unit San Antonio, Fort Sam Houston, Texas, USA
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2
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Zhang Q, Ma YX, Dai Z, Zhang B, Liu SS, Li WX, Fu CQ, Wang QM, Yin W. Tracking Research on Hemoglobin-Based Oxygen Carriers: A Scientometric Analysis and In-Depth Review. Drug Des Devel Ther 2023; 17:2549-2571. [PMID: 37645624 PMCID: PMC10461757 DOI: 10.2147/dddt.s422770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
Numerous studies on the formulation and clinical applications of novel hemoglobin-based oxygen carriers (HBOCs) are reported in the scientific literature. However, there are fewer scientometric analysis related to HBOCs. Here, we illustrate recent studies on HBOCs using both a scientometric analysis approach and a scope review method. We used the former to investigate research on HBOCs from 1991 to 2022, exploring the current hotspots and research trends, and then we comprehensively analyzed the relationship between concepts based on the keyword analysis. The evolution of research fields, knowledge structures, and research topics in which HBOCs located are revealed by scientometric analysis. The elucidation of type, acting mechanism, potential clinical practice, and adverse effects of HBOCs helps to clarify the prospects of this biological agent. Scientometrics analyzed 1034 publications in this research field, and these findings provide a promising roadmap for further study.
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Affiliation(s)
- Qi Zhang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Yue-Xiang Ma
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Zheng Dai
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Bin Zhang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Shan-Shou Liu
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Wen-Xiu Li
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Chuan-Qing Fu
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Qian-Mei Wang
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
| | - Wen Yin
- Department of Emergency, Xijing Hospital, Air Force Medical University, Xi’an, People’s Republic of China
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3
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Williams MC, Zhang X, Baek JH, D’Agnillo F. Renal glomerular and tubular responses to glutaraldehyde- polymerized human hemoglobin. Front Med (Lausanne) 2023; 10:1158359. [PMID: 37384048 PMCID: PMC10293615 DOI: 10.3389/fmed.2023.1158359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
Hemoglobin-based oxygen carriers (HBOCs) are being developed as oxygen and volume replacement therapeutics, however, their molecular and cellular effects on the vasculature and different organ systems are not fully defined. Using a guinea pig transfusion model, we examined the renal glomerular and tubular responses to PolyHeme, a highly characterized glutaraldehyde-polymerized human hemoglobin with low tetrameric hemoglobin content. PolyHeme-infused animals showed no major changes in glomerular histology or loss of specific markers of glomerular podocytes (Wilms tumor 1 protein, podocin, and podocalyxin) or endothelial cells (ETS-related gene and claudin-5) after 4, 24, and 72 h. Relative to sham controls, PolyHeme-infused animals also showed similar expression and subcellular distribution of N-cadherin and E-cadherin, two key epithelial junctional proteins of proximal and distal tubules, respectively. In terms of heme catabolism and iron-handling responses, PolyHeme induced a moderate but transient expression of heme oxygenase-1 in proximal tubular epithelium and tubulointerstitial macrophages that was accompanied by increased iron deposition in tubular epithelium. Contrary to previous findings with other modified or acellular hemoglobins, the present data show that PolyHeme does not disrupt the junctional integrity of the renal glomerulus and tubular epithelium, and triggers moderate activation of heme catabolic and iron sequestration systems likely as part of a renal adaptive response.
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4
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Mohanto N, Park YJ, Jee JP. Current perspectives of artificial oxygen carriers as red blood cell substitutes: a review of old to cutting-edge technologies using in vitro and in vivo assessments. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2023; 53:153-190. [PMID: 35935469 PMCID: PMC9344254 DOI: 10.1007/s40005-022-00590-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/02/2022] [Indexed: 01/06/2023]
Abstract
Background Several circumstances such as accidents, surgery, traumatic hemorrhagic shock, and other causalities cause major blood loss. Allogenic blood transfusion can be resuscitative for such conditions; however, it has numerous ambivalent effects, including supply shortage, needs for more time, cost for blood grouping, the possibility of spreading an infection, and short shelf-life. Hypoxia or ischemia causes heart failure, neurological problems, and organ damage in many patients. To address this emergent medical need for resuscitation and to treat hypoxic conditions as well as to enhance oxygen transportation, researchers aspire to achieve a robust technology aimed to develop safe and feasible red blood cell substitutes for effective oxygen transport. Area covered This review article provides an overview of the formulation, storage, shelf-life, clinical application, side effects, and current perspectives of artificial oxygen carriers (AOCs) as red blood cell substitutes. Moreover, the pre-clinical (in vitro and in vivo) assessments for the evaluation of the efficacy and safety of oxygen transport through AOCs are key considerations in this study. With the most significant technologies, hemoglobin- and perfluorocarbon-based oxygen carriers as well as other modern technologies, such as synthetically produced porphyrin-based AOCs and oxygen-carrying micro/nanobubbles, have also been elucidated. Expert opinion Both hemoglobin- and perfluorocarbon-based oxygen carriers are significant, despite having the latter acting as safeguards; they are cost-effective, facile formulations which penetrate small blood vessels and remove arterial blockages due to their nano-size. They also show better biocompatibility and longer half-life circulation than other similar technologies.
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Affiliation(s)
- Nijaya Mohanto
- College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452 Republic of Korea
| | - Young-Joon Park
- College of Pharmacy, Ajou University, Suwon, Gyeonggi, Republic of Korea
| | - Jun-Pil Jee
- College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452 Republic of Korea
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5
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Pantalone D, Chiara O, Henry S, Cimbanassi S, Gupta S, Scalea T. Facing Trauma and Surgical Emergency in Space: Hemorrhagic Shock. Front Bioeng Biotechnol 2022; 10:780553. [PMID: 35845414 PMCID: PMC9283715 DOI: 10.3389/fbioe.2022.780553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Although the risk of trauma in space is low, unpredictable events can occur that may require surgical treatment. Hemorrhage can be a life-threatening condition while traveling to another planet and after landing on it. These exploration missions call for a different approach than rapid return to Earth, which is the policy currently adopted on the International Space Station (ISS) in low Earth orbit (LEO). Consequences are difficult to predict, given the still scarce knowledge of human physiology in such environments. Blood loss in space can deplete the affected astronaut’s physiological reserves and all stored crew supplies. In this review, we will describe different aspects of hemorrhage in space, and by comparison with terrestrial conditions, the possible solutions to be adopted, and the current state of the art.
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Affiliation(s)
- D. Pantalone
- Department of Experimental and Clinical Medicine, Fellow of the American College of Surgeons, Core Board and Head for Studies on Traumatic Events and Surgery in the European Space Agency-Topical Team on “Tissue Healing in Space Techniques for Promoting and Monitoring Tissue Repair and Regeneration” for Life Science Activities Agency, Assistant Professor in General Surgery, Specialist in Vascular Surgery, Emergency Surgery Unit–Trauma Team, Emergency Department–Careggi University Hospital, University of Florence, Florence, Italy
- *Correspondence: D. Pantalone,
| | - O. Chiara
- Fellow of the American College of Surgeons, Director of General Surgery–Trauma Team, ASST GOM Grande Ospedale Metropolitano Niguarda, Professor of Surgery, University of Milan, Milan, Italy
| | - S. Henry
- Fellow of the American College of Surgeons, Director Division of Wound Healing and Metabolism, R Adams Cowley Shock Trauma Center University of Maryland, Baltimore, MD, United States
| | - S. Cimbanassi
- Fellow of the American College of Surgeons, EMDM, Vice Director of General Surgery-Trauma Team, ASST GOM Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - S. Gupta
- Fellow of the American College of Surgeons, R Adams Cowl y Shock Trauma Center, University of Maryland, Baltimore, MD, United States
| | - T. Scalea
- Fellow of the American College of Surgeons, The Honorable Francis X. Kelly Distinguished Professor of Trauma Surgery.Physician-in-Chief, R Adams Cowley Shock Trauma Center, System Chief for Critical Care Services, University of Maryland Medical System, University of Maryland, Baltimore, MD, United States
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6
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Barrett CD, Theodore S, Dechert T, Burke P, Khoury R, Cap AP, Scantling D. Resuscitation of an exsanguinated obstetrics patient with HBOC-201: A case report. Transfusion 2022; 62 Suppl 1:S218-S223. [PMID: 35748693 DOI: 10.1111/trf.16973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND 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. STUDY DESIGN AND METHODS 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. RESULTS 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. DISCUSSION 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.
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Affiliation(s)
- Christopher D Barrett
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Koch Institute, Center for Precision Cancer Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Division of Trauma and Acute Care Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sheina Theodore
- Division of Trauma and Acute Care Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tracey Dechert
- Division of Trauma and Acute Care Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Peter Burke
- Division of Trauma and Acute Care Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rasha Khoury
- Department of Obstetrics and Gynecology, Boston University Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrew P Cap
- US Army Medical Corps, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Dane Scantling
- Division of Trauma and Acute Care Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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7
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Zhang J, Wu Y, Peng XY, Li QH, Xiang XM, Zhu Y, Yan QG, Lau B, Tzang F, Liu LM, Li T. The Protective Effect of a Novel Cross-Linked Hemoglobin-Based Oxygen Carrier on Hypoxia Injury of Acute Mountain Sickness in Rabbits and Goats. Front Physiol 2021; 12:690190. [PMID: 34646146 PMCID: PMC8502813 DOI: 10.3389/fphys.2021.690190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Hypoxia is the major cause of acute altitude hypoxia injury in acute mountain sickness (AMS). YQ23 is a kind of novel bovine-derived, cross-linked hemoglobin-based oxygen carrier (HBOC). It has an excellent capacity for carrying and releasing oxygen. Whether YQ23 has a protective effect on the acute altitude hypoxia injury in AMS is unclear. In investigating this mechanism, the hypobaric chamber rabbit model and plain-to-plateau goat model were used. Furthermore, this study measured the effects of YQ23 on the ability of general behavior, general vital signs, Electrocardiograph (ECG), hemodynamics, vital organ injury markers, and blood gases in hypobaric chamber rabbits and plain-to-plateau goats. Our results showed that the ability of general behavior (general behavioral scores, GBS) (GBS: 18 ± 0.0 vs. 14 ± 0.5, p < 0.01) and the general vital signs weakened [Heart rate (HR, beats/min): 253.5 ± 8.7 vs. 301.1 ± 19.8, p < 0.01; Respiratory rate (RR, breaths/min): 86.1 ± 5.2 vs. 101.2 ± 7.2, p < 0.01] after exposure to plateau environment. YQ23 treatment significantly improved the ability of general behavior (GBS: 15.8 ± 0.5 vs. 14.0 ± 0.5, p < 0.01) and general vital signs [HR (beats/min): 237.8 ± 24.6 vs. 301.1 ± 19.8, p < 0.01; RR (breaths/min): 86.9 ± 6.6 vs. 101.2 ± 7.2, p < 0.01]. The level of blood PaO2 (mmHg) (115.3 ± 4.7 vs. 64.2 ± 5.6, p < 0.01) and SaO2(%) (97.7 ± 0.7 vs. 65.8 ± 3.1, p < 0.01) sharply decreased after exposure to plateau, YQ23 treatment significantly improved the blood PaO2 (mmHg) (97.6 ± 3.7 vs. 64.2 ± 5.6, p < 0.01) and SaO2(%) (82.7 ± 5.2 vs. 65.8 ± 3.1, p < 0.01). The cardiac ischemia and injury marker was increased [troponin (TnT, μg/L):0.08 ± 0.01 vs. 0.12 ± 0.02, p < 0.01], as well as the renal [blood urea nitrogen (BUN, mmol/L): 6.0 ± 0.7 vs. 7.3 ± 0.5, p < 0.01] and liver injury marker [alanine aminotransferase (ALT, U/L): 45.8 ± 3.6 vs. 54.6 ± 4.2, p < 0.01] was increased after exposure to a plateau environment. YQ23 treatment markedly alleviated cardiac ischemia [TnT (μg/L):0.10 ± 0.01 vs 0.12 ± 0.02, p < 0.01] and mitigated the vital organ injury. Besides, YQ23 exhibited no adverse effects on hemodynamics, myocardial ischemia, and renal injury. In conclusion, YQ23 effectively alleviates acute altitude hypoxia injury of AMS without aside effects.
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Affiliation(s)
- Jie Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yue Wu
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiao-Yong Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Qing-Hui Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xin-Ming Xiang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yu Zhu
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Qing-Guang Yan
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Billy Lau
- New Beta Innovation Limited, Kowloon Bay, Hong Kong, SAR China
| | - Feichuen Tzang
- New Beta Innovation Limited, Kowloon Bay, Hong Kong, SAR China
| | - Liang-Ming Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Tao Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Shock and Transfusion, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
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8
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Weiskopf RB, Davenport R, Cap AP, Reddy V, Waters JH, Cserti-Gazdewich C. Increasing hemoglobin concentration with an artificial oxygen carrier improves severe anemia-induced degraded cognitive function. J Trauma Acute Care Surg 2021; 91:S182-S185. [PMID: 33951026 DOI: 10.1097/ta.0000000000003261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
ABSTRACT Before death, patients commonly experience impaired consciousness for a significant period, frequently preventing family and others from final interactions with the patient. Some of these episodes of cognitive impairment may be treatable, with treatment not offered owing to the perception of ultimate futility or expense, or both. One of the causes of terminal loss of consciousness or decreased lucidity can be inadequate cerebral oxygen delivery. We report five cases from four institutions where an infusion of a hemoglobin-based oxygen carrier to patients who were unconscious or not lucid owing to acute severe anemia (hemoglobin range, 2.1-5.2 g/dL) resulted in awakening or lucidity. We review briefly human cognitive function and anemia and remark about the use of a hemoglobin-based oxygen carrier for acute severe anemia when red cell transfusion is not an option.
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Affiliation(s)
- Richard B Weiskopf
- From the Department of Anesthesia and Perioperative Care, University of California (R.B.W.), San Francisco, California; Department of Pathology (R.D.), University of Michigan Medical School; US Army Institute of Surgical Research (A.P.C.), JBSA-Ft Sam Houston, San Antonio, Texas; Department of Medicine (A.P.C.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Pulmonary and Critical Care Medicine (V.R.), Wellstar Health System, Marietta, Georgia; Department of Anesthesiology and Perioperative Medicine and Bioengineering (J.H.W.), University of Pittsburgh, Pittsburgh, Pennsylvania; and Laboratory Medicine Program (C.C.-G.) and Department of Medical Oncology and Hematology (C.C.-G.), University Health Network, University of Toronto, Toronto, Ontario, Canada
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9
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Perioperative Management of Patients for Whom Transfusion Is Not an Option. Anesthesiology 2021; 134:939-948. [PMID: 33857295 DOI: 10.1097/aln.0000000000003763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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11
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Jahr JS, Guinn NR, Lowery DR, Shore-Lesserson L, Shander A. Blood Substitutes and Oxygen Therapeutics: A Review. Anesth Analg 2021; 132:119-129. [PMID: 30925560 DOI: 10.1213/ane.0000000000003957] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite the exhaustive search for an acceptable substitute to erythrocyte transfusion, neither chemical-based products such as perfluorocarbons nor hemoglobin-based oxygen carriers have succeeded in providing a reasonable alternative to allogeneic blood transfusion. However, there remain scenarios in which blood transfusion is not an option, due to patient's religious beliefs, inability to find adequately cross-matched erythrocytes, or in remote locations. In these situations, artificial oxygen carriers may provide a mortality benefit for patients with severe, life-threatening anemia. This article provides an up-to-date review of the history and development, clinical trials, new technology, and current standing of artificial oxygen carriers as an alternative to transfusion when blood is not an option.
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Affiliation(s)
- Jonathan S Jahr
- From the David Geffen School of Medicine at University of California Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Nicole R Guinn
- Department of Anesthesiology, Center for Blood Conservation Duke University Medical Center, Durham, North Carolina
| | - David R Lowery
- US Military, San Antonio, Texas.,Department of Anesthesiology, Uniformed Services University of the Health Sciences, San Antonio Military Medical Center, San Antonio, Texas
| | | | - Aryeh Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey.,TeamHealth Research Institute, Englewood Hospital and Medical Center, Englewood, New Jersey
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12
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Coll-Satue C, Bishnoi S, Chen J, Hosta-Rigau L. Stepping stones to the future of haemoglobin-based blood products: clinical, preclinical and innovative examples. Biomater Sci 2021; 9:1135-1152. [DOI: 10.1039/d0bm01767a] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Critical overview of the different oxygen therapeutics developed so far to be used when donor blood is not available.
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Affiliation(s)
- Clara Coll-Satue
- Department of Health Technology
- Centre for Nanomedicine and Theranostics
- DTU Health Tech
- Technical University of Denmark
- 2800 Lyngby
| | - Shahana Bishnoi
- Department of Health Technology
- Centre for Nanomedicine and Theranostics
- DTU Health Tech
- Technical University of Denmark
- 2800 Lyngby
| | - Jiantao Chen
- Department of Health Technology
- Centre for Nanomedicine and Theranostics
- DTU Health Tech
- Technical University of Denmark
- 2800 Lyngby
| | - Leticia Hosta-Rigau
- Department of Health Technology
- Centre for Nanomedicine and Theranostics
- DTU Health Tech
- Technical University of Denmark
- 2800 Lyngby
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13
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Weiskopf RB, Glassberg E, Guinn NR, James MFM, Ness PM, Pusateri AE. The need for an artificial oxygen carrier for disasters and pandemics, including COVID-19. Transfusion 2020; 60:3039-3045. [PMID: 32978804 PMCID: PMC7537157 DOI: 10.1111/trf.16122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 01/29/2023]
Affiliation(s)
| | - Elon Glassberg
- The Israel Defense Force Medical Corps, Ramat Gan, Israel.,Departments of Surgery, Bar-Ilan University Faculty of Medicine, Safed, Israel, and The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nicole R Guinn
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael F M James
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Paul M Ness
- Transfusion Medicine Division, Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
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14
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Relative Efficacies of HBOC-201 and Polyheme to Increase Oxygen Transport Compared to Blood and Crystalloids. Shock 2020; 52:100-107. [PMID: 29140831 DOI: 10.1097/shk.0000000000001058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Because total hemoglobin in circulation ([THb]) is an established predictor of clinical outcomes in anemic individuals, the relative efficacies of resuscitation fluids to increase [THb] can be used to design better hemoglobin-based oxygen carrier (HBOC) clinical trials. METHODS Expected efficacies of HBOC-201 (13 g Hb/dL) and packed red blood cells (RBCs) (packed red blood cells [pRBCs], 24 g Hb/dL) to increase [THb] were calculated and interpreted in the context of severe adverse events (SAEs) in the HEM-0115 phase III clinical trial.The PolyHeme phase III clinical trial compared the HBOC, PolyHeme (10 g Hb/dL), with crystalloid control prehospital and packed RBCs in hospital. The comparative abilities of these resuscitation fluids to maintain [THb] were interpreted in the context of mortality. RESULTS In HEM-0115, infusion of HBOC-201 increased [THb] by 0.18 ± 0.03 g/dL (N=121) compared with 0.87 ± 0.07 g/dL (n = 115) following one unit of pRBCs. These observed increases in [THb] were similar to expected increases for these fluids. Use of HBOC-201 was associated with 0.34 SAEs per patient compared with 0.25 SAEs per patient in the pRBC arm (P = 0.016).Hemoglobin Deficit was greater in HBOC-201-treated patients than in pRBC controls and emerged as a predictor of SAEs in a logistics model. Randomization to HBOC-201 had no power to predict SAEs.PolyHeme more effectively maintained [THb] than did crystalloid prior to arrival at hospital, associated with initially higher survival in the PolyHeme arm. Thereafter, PolyHeme subjects sustained lower [THb] and higher mortality than controls. CONCLUSION Greater anemia in subjects randomized to HBOC-201 was consistent with the relative efficacies of HBOC-201 and pRBCs to increase [THb] and may have contributed to more SAEs in the HBOC arm of HEM-0115 and greater long-term mortality in the PolyHeme trial.
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Abstract
Several adverse events have been associated with the infusion of hemoglobin-based oxygen carriers (HBOCs), including transient hypertension, gastrointestinal, pancreatic/liver enzyme elevation, and cardiac/renal injury in humans. Although several mechanisms have been suggested, the basis of HBOC toxicity is still poorly understood. Scavenging of vascular endothelial nitric oxide (NO) and heme-mediated oxidative side reactions are thought to be the major causes of toxicity. However, based on more recent preclinical studies, oxidative pathways (driven by the heme prosthetic group) seem to play a more prominent role in the overall toxicity of free Hb or HBOCs. HBOCs display a diversity of physicochemical properties, including molecular size/cross-linking characteristics leading to differences in oxygen affinity, allosteric, redox properties, and even oxidative inactivation by protein/heme clearing mechanisms. These diverse characteristics can therefore be manipulated independently, leaving open the possibility of engineering a safe and effective HBOC. To date, several antioxidative strategies have been proposed to counteract the redox side reactions of current generation HBOCs.
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Artificial oxygen carriers and red blood cell substitutes: A historic overview and recent developments toward military and clinical relevance. J Trauma Acute Care Surg 2020; 87:S48-S58. [PMID: 31246907 DOI: 10.1097/ta.0000000000002250] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Packed red blood cells are a critical component in the resuscitation of hemorrhagic shock. The availability of donor-derived blood products, however, suffers from issues of supply, immunogenicity, and pathogenic contamination. Deployment in remote or austere environments, such as the battlefield, is further hindered by the inherent perishability of blood products. To address the significant limitations of allogenic packed red blood cells and the urgent medical need for better resuscitative therapies for both combat casualties and civilians, there has been significant research invested in developing safe, effective, and field deployable artificial oxygen carriers. This article provides a comprehensive review of the most important technologies in the field of artificial oxygen carriers including cell-free and encapsulated hemoglobin-based oxygen carriers, perfluorocarbon emulsions, natural hemoglobin alternatives, as well as other novel technologies. Their development status, clinical, and military relevance are discussed. LEVEL OF EVIDENCE: Systematic review.
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Zumberg M, Gorlin J, Griffiths EA, Schwartz G, Fletcher BS, Walsh K, Dao KH, Vansandt A, Lynn M, Shander A. A case study of 10 patients administered HBOC-201 in high doses over a prolonged period: outcomes during severe anemia when transfusion is not an option. Transfusion 2020; 60:932-939. [PMID: 32358832 DOI: 10.1111/trf.15778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/25/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hemoglobin-Based Oxygen Carriers (HBOCs) can act as an "oxygen bridge" in acute severe anemia when transfusion is indicated, but not possible. We present data on 10 Expanded Access (EA) patients treated with high cumulative doses of Hemopure (HBOC-201), to assess the ability of HBOC-201 to safely treat life threatening anemia in situations where high volumes of product were administered over an extended period of time. STUDY DESIGN AND METHODS Inclusion in this study required that the patient receive at least 10 units of HBOC-201 between 2014 and 2017 under the FDA-sanctioned EA program. Depending on a patient's geographical location, treatment with HBOC-201 was obtained through either a single patient emergency Investigational New Drug (IND) application, or an intermediate size population IND. Of the 41 patients who were treated during this period, 10 patients received 10 or more units of the product. Data were obtained from medical records. RESULTS Treatments with HBOC-201 started within 24 hours of signing consent and were administered at an average rate of 1.99 (SD 0.17) units per day over a mean of 8.2 days (SD 2.9), during which patients received on average 16.2 units (SD 5.7 units) of HBOC-201. The median pre-treatment nadir corpuscular hemoglobin (Hb) concentration was 3.3 (SD 0.9) g/dL and post-treatment Hemoglobin was 7.3 (SD 1.7) g/dL. Common side effects included methemoglobinemia, gastrointestinal symptoms, and hypertension. However, no product-related serious adverse events (SAEs) were noted. All patients survived. CONCLUSIONS Administration of HBOC-201 over an extended period is a feasible and safe oxygen bridge for severely anemic patients who cannot be transfused with RBC.
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Affiliation(s)
- Marc Zumberg
- Division of Hematology/Oncology, University of Florida Shands Cancer Hospital, Gainesville, Florida, USA
| | - Jed Gorlin
- Transfusion Service, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth A Griffiths
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Bradley S Fletcher
- Division of Hematology and Oncology, University of Florida Shands Cancer Hospital, Gainesville, Florida, USA
| | - Katherine Walsh
- Division of Hematology, The Ohio State University Comprehensive Cancer Center Columbus, Columbus, Ohio, USA
| | - Kim-Hien Dao
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Amanda Vansandt
- Department of Pathology, Oregon Health & Science University Portland, Portland, Oregon, USA
| | - Mauricio Lynn
- Ryder Trauma Center, Jackson Memorial Hospital, University of Miami Medical School, Miami, Florida, USA
| | - Aryeh Shander
- Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Team Health Research Institute, Englewood Medical Center, Englewood, New Jersey, USA
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18
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Lower hemoglobin concentration decreases time to death in severely anemic patients for whom blood transfusion is not an option. J Trauma Acute Care Surg 2020; 88:803-808. [DOI: 10.1097/ta.0000000000002632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Selective aortic arch perfusion with fresh whole blood or HBOC-201 reverses hemorrhage-induced traumatic cardiac arrest in a lethal model of noncompressible torso hemorrhage. J Trauma Acute Care Surg 2020; 87:263-273. [PMID: 31348400 DOI: 10.1097/ta.0000000000002315] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhage-induced traumatic cardiac arrest (HiTCA) has a dismal survival rate. Previous studies demonstrated selective aortic arch perfusion (SAAP) with fresh whole blood (FWB) improved the rate of return of spontaneous circulation (ROSC) after HiTCA, compared with resuscitative endovascular balloon occlusion of the aorta and cardiopulmonary resuscitation (CPR). Hemoglobin-based oxygen carriers, such as hemoglobin-based oxygen carrier (HBOC)-201, may alleviate the logistical constraints of using FWB in a prehospital setting. It is unknown whether SAAP with HBOC-201 is equivalent in efficacy to FWB, whether conversion from SAAP to extracorporeal life support (ECLS) is feasible, and whether physiologic derangement post-SAAP therapy is reversible. METHODS Twenty-six swine (79 ± 4 kg) were anesthetized and underwent HiTCA which was induced via liver injury and controlled hemorrhage. Following arrest, swine were randomly allocated to resuscitation using SAAP with FWB (n = 12) or HBOC-201 (n = 14). After SAAP was initiated, animals were monitored for a 20-minute prehospital period prior to a 40-minute damage control surgery and resuscitation phase, followed by 260 minutes of critical care. Primary outcomes included rate of ROSC, survival, conversion to ECLS, and correction of physiology. RESULTS Baseline physiologic measurements were similar between groups. ROSC was achieved in 100% of the FWB animals and 86% of the HBOC-201 animals (p = 0.483). Survival (t = 320 minutes) was 92% (11/12) in the FWB group and 67% (8/12) in the HBOC-201 group (p = 0.120). Conversion to ECLS was successful in 100% of both groups. Lactate peaked at 80 minutes in both groups, and significantly improved by the end of the experiment in the HBOC-201 group (p = 0.001) but not in the FWB group (p = 0.104). There was no significant difference in peak or end lactate between groups. CONCLUSION Selective aortic arch perfusion is effective in eliciting ROSC after HiTCA in a swine model, using either FWB or HBOC-201. Transition from SAAP to ECLS after definitive hemorrhage control is feasible, resulting in high overall survival and improvement in lactic acidosis over the study period.
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20
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El Chaer F, Ballen KK. Treatment of acute leukaemia in adult Jehovah's Witnesses. Br J Haematol 2019; 190:696-707. [PMID: 31693175 DOI: 10.1111/bjh.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/18/2019] [Indexed: 01/28/2023]
Abstract
Since Jehovah's Witness (JW) patients diagnosed with leukaemia refuse blood transfusions, they are often denied intensive chemotherapy for fear they could not survive myeloablation without blood transfusion support. Treatment of JW patients with acute leukaemia is challenging and carries a higher morbidity and mortality; however, the refusal of blood products should not be an absolute contraindication to offer multiple treatment modalities including haematopoietic stem cell transplantation. In this review we discuss their optimal management and describe alternative modalities to blood transfusions to provide sufficient oxygenation and prevent bleeding.
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Affiliation(s)
- Firas El Chaer
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen K Ballen
- Department of Medicine, Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
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21
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Tan GM, Guinn NR, Frank SM, Shander A. Proceedings From the Society for Advancement of Blood Management Annual Meeting 2017: Management Dilemmas of the Surgical Patient-When Blood Is Not an Option. Anesth Analg 2019; 128:144-151. [PMID: 29958216 DOI: 10.1213/ane.0000000000003478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vigilance is essential in the perioperative period. When blood is not an option for the patient, especially in a procedure/surgery that normally holds a risk for blood transfusion, complexity is added to the management. Current technology and knowledge has made avoidance of blood transfusion a realistic option but it does require a concerted patient-centered effort from the perioperative team. In this article, we provide suggestions for a successful, safe, and bloodless journey for patients. The approaches include preoperative optimization as well as intraoperative and postoperative techniques to reduce blood loss, and also introduces current innovative substitutes for transfusions. This article also assists in considering and maneuvering through the legal and ethical systems to respect patients' beliefs and ensuring their safety.
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Affiliation(s)
- Gee Mei Tan
- From the Department of Anesthesiology, University of Colorado, School of Medicine, Aurora, Colorado
| | - Nicole R Guinn
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Steven M Frank
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Aryeh Shander
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center and TeamHealth Research Institute, Englewood, New Jersey
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22
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Reassessment of the Need for an Oxygen Carrier for the Treatment of Traumatic Hemorrhage When Blood is not an Option. Shock 2019; 52:55-59. [DOI: 10.1097/shk.0000000000001417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Users Guide to Pitfalls and Lessons Learned About HBOC-201 During Clinical Trials, Expanded Access, and Clinical Use in 1,701 Patients. Shock 2019; 52:92-99. [DOI: 10.1097/shk.0000000000001038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Hemoglobin-based Oxygen Carriers (HBOC)—What the Next Generation Holds: When Red Blood Cells are not an Option. Shock 2019; 52:4-6. [DOI: 10.1097/shk.0000000000001421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Nowak ES, Reyes DP, Bryant BJ, Cap AP, Kerstman EL, Antonsen EL. Blood transfusion for deep space exploration. Transfusion 2019; 59:3077-3083. [DOI: 10.1111/trf.15493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 06/13/2019] [Accepted: 07/22/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Elizabeth S. Nowak
- MetroHealth Medical CenterCase Western Reserve University School of Medicine Cleveland Ohio
| | - David P. Reyes
- Aerospace Medicine, Department of Preventive Medicine and Community HealthUniversity of Texas Medical Branch Galveston Texas
- Exploration Medical CapabilityJohnson Space Center, NASA Houston Texas
| | - Barbara J. Bryant
- Transfusion Medicine, Department of PathologyUniversity of Texas Medical Branch Galveston Texas
| | - Andrew P. Cap
- Coagulation and Blood Research DepartmentUS Army Institute of Surgical Research Fort Sam Houston Texas
| | - Eric L. Kerstman
- Aerospace Medicine, Department of Preventive Medicine and Community HealthUniversity of Texas Medical Branch Galveston Texas
- Exploration Medical CapabilityJohnson Space Center, NASA Houston Texas
| | - Erik L. Antonsen
- Exploration Medical CapabilityJohnson Space Center, NASA Houston Texas
- Department of Emergency MedicineBaylor College of Medicine Houston Texas
- Center for Space MedicineBaylor College of Medicine Houston Texas
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26
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Pusateri AE, Butler FK, Shackelford SA, Sperry JL, Moore EE, Cap AP, Taylor AL, Homer MJ, Hoots WK, Weiskopf RB, Davis MR. The need for dried plasma - a national issue. Transfusion 2019; 59:1587-1592. [PMID: 30980738 DOI: 10.1111/trf.15261] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 01/10/2023]
Abstract
Recent studies have demonstrated that early transfusion of plasma or RBCs improves survival in patients with severe trauma and hemorrhagic shock. Time to initiate transfusion is the critical factor. It is essential that transfusion begin in the prehospital environment when transport times are longer than approximately 15 to 20 minutes. Unfortunately, logistic constraints severely limit the use of blood products in the prehospital setting, especially in military, remote civilian, and mass disaster circumstances, where the need can be most acute. US military requirements for logistically supportable blood products are projected to increase dramatically in future conflicts. Although dried plasma products have been available and safely used in a number of countries for over 20 years, there is no dried plasma product commercially available in the United States. A US Food and Drug Administration-approved dried plasma is urgently needed. Considering the US military, disaster preparedness, and remote civilian trauma perspectives, this is an urgent national health care issue.
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Affiliation(s)
- Anthony E Pusateri
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas
| | - Frank K Butler
- Committee on Tactical Combat Casualty Care, Joint Trauma System, Defense Center of Excellence for Trauma, JBSA, Fort Sam Houston
| | - Stacy A Shackelford
- Joint Trauma System, Defense Center of Excellence for Trauma, JBSA Fort Sam Houston, San Antonio, Texas
| | - Jason L Sperry
- Department of Surgery and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center, Denver, Colorado
| | - Andrew P Cap
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas
| | | | - Mary J Homer
- US Department of Health and Human Services (BARDA), Washington, DC
| | - W Keith Hoots
- National Institutes of Health (NHLBI), Bethesda, Maryland
| | | | - Michael R Davis
- US Army Medical Research and Materiel Command, Fort Detrick, Maryland
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27
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Jacquot C, Mo YD, Luban NLC. New Approaches and Trials in Pediatric Transfusion Medicine. Hematol Oncol Clin North Am 2019; 33:507-520. [PMID: 31030816 DOI: 10.1016/j.hoc.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Blood transfusions are frequently lifesaving, but there is growing awareness of their associated infectious and noninfectious adverse events. Patient blood management advocates for judicious use of transfusions and considerations of alternatives to correct anemia or achieve hemostasis. Several transfusion practices, either already implemented or under investigation, aim to further improve the safety of transfusions. An enduring challenge in pediatric and neonatal transfusion practice is that studies typically focus on adults, and findings are extrapolated to younger patients. This article aims to summarize some of the newer developments in transfusion medicine with a focus on the neonatal and pediatric population.
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Affiliation(s)
- Cyril Jacquot
- Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Yunchuan Delores Mo
- Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Naomi L C Luban
- Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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28
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Soril LJJ, Noseworthy TW, Stelfox HT, Zygun DA, Clement FM. Facilitators of and barriers to adopting a restrictive red blood cell transfusion practice: a population-based cross-sectional survey. CMAJ Open 2019; 7:E252-E257. [PMID: 31018970 PMCID: PMC6498447 DOI: 10.9778/cmajo.20180209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Despite recommendations for restrictive approaches to red blood cell transfusion in the intensive care unit (ICU), variation from best practices persists. The aim of this study was to explore potential facilitators of and barriers to practising a restrictive red blood cell transfusion strategy among intensive care physicians using the theoretical domains framework. METHODS We conducted an online population-based cross-sectional survey of all intensive care physicians in 1 health care system (Alberta). Survey questions were based on 6 key theoretical domains of the theoretical domains framework: Knowledge, Social/professional roles and identity, Motivation and goals, Beliefs about consequences, Social influences and Beliefs about capabilities. The survey was administered between July 27 and Oct. 6, 2017. Descriptive statistics (demographic and Likert scale data) and conventional content analysis (open-ended responses) were conducted. RESULTS Forty-two intensive care physicians completed the survey (estimated response rate 56%). The respondents identified knowledge of published evidence, use of guidelines, improved outcomes, physician autonomy, and perceived culture of acceptance and collegial support as facilitators of practising a restrictive transfusion strategy. Identified barriers included potential impact on and cost to other clinical goals, conflicting practices and beliefs of physicians in other clinical specialties, deficits in medical trainees' skills and knowledge, and attitudinal barriers related to denial. INTERPRETATION Using the theoretical domains framework, we identified 9 key self-reported facilitators of and barriers to intensive care physicians' transfusion behaviour. Understanding these determinants will help inform development and implementation of interventions within ICUs to encourage optimal use of red blood cell transfusion practices for nonbleeding patients whose condition is stable.
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Affiliation(s)
- Lesley J J Soril
- Departments of Community Health Sciences (Soril, Noseworthy, Stelfox, Clement) and Critical Care Medicine (Stelfox), Cumming School of Medicine, and O'Brien Institute for Public Health (Soril, Noseworthy, Stelfox, Clement), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Zygun), Alberta Health Services; Faculty of Medicine and Dentistry (Zygun), University of Alberta, Edmonton, Alta
| | - Tom W Noseworthy
- Departments of Community Health Sciences (Soril, Noseworthy, Stelfox, Clement) and Critical Care Medicine (Stelfox), Cumming School of Medicine, and O'Brien Institute for Public Health (Soril, Noseworthy, Stelfox, Clement), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Zygun), Alberta Health Services; Faculty of Medicine and Dentistry (Zygun), University of Alberta, Edmonton, Alta
| | - Henry T Stelfox
- Departments of Community Health Sciences (Soril, Noseworthy, Stelfox, Clement) and Critical Care Medicine (Stelfox), Cumming School of Medicine, and O'Brien Institute for Public Health (Soril, Noseworthy, Stelfox, Clement), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Zygun), Alberta Health Services; Faculty of Medicine and Dentistry (Zygun), University of Alberta, Edmonton, Alta
| | - David A Zygun
- Departments of Community Health Sciences (Soril, Noseworthy, Stelfox, Clement) and Critical Care Medicine (Stelfox), Cumming School of Medicine, and O'Brien Institute for Public Health (Soril, Noseworthy, Stelfox, Clement), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Zygun), Alberta Health Services; Faculty of Medicine and Dentistry (Zygun), University of Alberta, Edmonton, Alta
| | - Fiona M Clement
- Departments of Community Health Sciences (Soril, Noseworthy, Stelfox, Clement) and Critical Care Medicine (Stelfox), Cumming School of Medicine, and O'Brien Institute for Public Health (Soril, Noseworthy, Stelfox, Clement), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Zygun), Alberta Health Services; Faculty of Medicine and Dentistry (Zygun), University of Alberta, Edmonton, Alta.
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29
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Shander A, Goodnough LT. Management of anemia in patients who decline blood transfusion. Am J Hematol 2018; 93:1183-1191. [PMID: 30033541 DOI: 10.1002/ajh.25167] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 12/26/2022]
Abstract
Declining a treatment modality should not be considered the same as refusal of medical care as illustrated by the management of Jehovah's Witness patients who do not accept transfusions. Over the years, a comprehensive set of strategies have been developed to meet the specific needs of these patients and these strategies are collectively called "Bloodless Medicine and Surgery" (BMS). The focus in BMS is to optimize the patients' hematopoietic capacity to increase hemoglobin (Hgb) level, minimize blood loss, improve hemostasis, and provide supportive strategies to minimize oxygen consumption and maximize oxygen utilization. We present 3 case reports that illustrate some of the challenges faced and measures available to effectively treat these patients. Under BMS programs, patients with extremely low hemoglobin levels, not conducive to survival under ordinary conditions, have survived and recovered without receiving allogeneic transfusions. Additionally, the valuable experience gained from caring for these patients has paved the way to develop the concept of Patient Blood Management as a standard care to benefit all patients, and not only those for whom blood is not an option.
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology and Critical Care medicine; Englewood Hospital and Medical Center, and TeamHealth Research Institute; Englewood New Jersey
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30
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Guo C, Chang TMS. Long term safety and immunological effects of a nanobiotherapeutic, bovine poly-[hemoglobin-catalase-superoxide dismutase-carbonic anhydrase], after four weekly 5% blood volume top-loading followed by a challenge of 30% exchange transfusion. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2018; 46:1349-1363. [DOI: 10.1080/21691401.2018.1476375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Chen Guo
- Artficial Cells and Organs Research Centre, Departments of Physiology, Medicine and Biomedical Engineering, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Thomas Ming Swi Chang
- Artficial Cells and Organs Research Centre, Departments of Physiology, Medicine and Biomedical Engineering, Faculty of Medicine, McGill University, Montreal, QC, Canada
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31
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Zhang X, Williams MC, Rentsendorj O, D’Agnillo F. Reversible renal glomerular dysfunction in guinea pigs exposed to glutaraldehyde-polymerized cell-free hemoglobin. Toxicology 2018; 402-403:37-49. [DOI: 10.1016/j.tox.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 01/17/2023]
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32
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Guinn NR, Cooter ML, Villalpando C, Weiskopf RB. Severe anemia associated with increased risk of death and myocardial ischemia in patients declining blood transfusion. Transfusion 2018; 58:2290-2296. [DOI: 10.1111/trf.14768] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Nicole R. Guinn
- Department of Anesthesiology; Duke University Medical Center; Durham North Carolina
| | - Mary L. Cooter
- Department of Anesthesiology; Duke University Medical Center; Durham North Carolina
| | - Claudia Villalpando
- Department of Anesthesiology; Garfield Medical Center; Monterey Park California
| | - Richard B. Weiskopf
- Department of Anesthesiology; University of California; San Francisco California
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Soril LJJ, Noseworthy TW, Dowsett LE, Memedovich K, Holitzki HM, Lorenzetti DL, Stelfox HT, Zygun DA, Clement FM. Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis. BMJ Open 2018; 8:e019912. [PMID: 29776919 PMCID: PMC5961610 DOI: 10.1136/bmjopen-2017-019912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To assess the impact of behaviour modification interventions to promote restrictive red blood cell (RBC) transfusion practices. DESIGN Systematic review and meta-analysis. SETTING, PARTICIPANTS, INTERVENTIONS Seven electronic databases were searched to January 2018. Published randomised controlled trials (RCTs) or non-randomised studies examining an intervention to modify healthcare providers' RBC transfusion practice in any healthcare setting were included. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the proportion of patients transfused. Secondary outcomes included the proportion of inappropriate transfusions, RBC units transfused per patient, in-hospital mortality, length of stay (LOS), pretransfusion haemoglobin and healthcare costs. Meta-analysis was conducted using a random-effects model and meta-regression was performed in cases of heterogeneity. Publication bias was assessed by Begg's funnel plot. RESULTS Eighty-four low to moderate quality studies were included: 3 were RCTs and 81 were non-randomised studies. Thirty-one studies evaluated a single intervention, 44 examined a multimodal intervention. The comparator in all studies was standard of care or historical control. In 33 non-randomised studies, use of an intervention was associated with reduced odds of transfusion (OR 0.63 (95% CI 0.56 to 0.71)), odds of inappropriate transfusion (OR 0.46 (95% CI 0.36 to 0.59)), RBC units/patient weighted mean difference (WMD: -0.50 units (95% CI -0.85 to -0.16)), LOS (WMD: -1.14 days (95% CI -2.12 to -0.16)) and pretransfusion haemoglobin (-0.28 g/dL (95% CI -0.48 to -0.08)). There was no difference in odds of mortality (OR 0.90 (95% CI 0.80 to 1.02)). Protocol/algorithm and multimodal interventions were associated with the greatest decreases in the primary outcome. There was high heterogeneity among estimates and evidence for publication bias. CONCLUSIONS The literature examining the impact of interventions on RBC transfusions is extensive, although most studies are non-randomised. Despite this, pooled analysis of 33 studies revealed improvement in the primary outcome. Future work needs to shift from asking, 'does it work?' to 'what works best and at what cost?' PROSPERO REGISTRATION NUMBER CRD42015024757.
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Affiliation(s)
- Lesley J J Soril
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Thomas W Noseworthy
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Laura E Dowsett
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Katherine Memedovich
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Hannah M Holitzki
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - David A Zygun
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Critical Care Medicine, Alberta Health Services and Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
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Spahn DR. Artificial oxygen carriers: a new future? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:46. [PMID: 29471841 PMCID: PMC5824566 DOI: 10.1186/s13054-018-1949-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/09/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Donat R Spahn
- Institute of Anesthesiology, Anesthesiology - Intensive Care Medicine - OR-Management, University of Zurich and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Olaussen A, Bade-Boon J, Fitzgerald MC, Mitra B. Management of injured patients who were Jehovah's Witnesses, where blood transfusion may not be an option: a retrospective review. Vox Sang 2018; 113:283-289. [DOI: 10.1111/vox.12637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A. Olaussen
- National Trauma Research Institute; The Alfred Hospital; Melbourne Vic. Australia
- Trauma Service; The Alfred Hospital; Melbourne Vic. Australia
- Emergency & Trauma Centre; The Alfred Hospital; Melbourne Vic. Australia
- Department of Community Emergency Health and Paramedic Practice; Monash University; Melbourne Vic. Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - J. Bade-Boon
- National Trauma Research Institute; The Alfred Hospital; Melbourne Vic. Australia
| | - M. C. Fitzgerald
- National Trauma Research Institute; The Alfred Hospital; Melbourne Vic. Australia
- Trauma Service; The Alfred Hospital; Melbourne Vic. Australia
| | - B. Mitra
- National Trauma Research Institute; The Alfred Hospital; Melbourne Vic. Australia
- Emergency & Trauma Centre; The Alfred Hospital; Melbourne Vic. Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
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Davis JM, El-Haj N, Shah NN, Schwartz G, Block M, Wall J, Tidswell M, DiNino E. Use of the blood substitute HBOC-201 in critically ill patients during sickle crisis: a three-case series. Transfusion 2017; 58:132-137. [DOI: 10.1111/trf.14386] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Jonathan M. Davis
- Baystate Medical Center, Tufts University School of Medicine; Springfield Massachusetts
| | - Nura El-Haj
- Baystate Medical Center, Tufts University School of Medicine; Springfield Massachusetts
| | - Nimish N. Shah
- Tufts University School of Medicine; Boston Massachusetts
| | - Garry Schwartz
- Levine Cancer Institute, Carolinas Healthcare System; Charlotte North Carolina
| | - Margaret Block
- CHI Health/Creighton University and Methodist Health System; Omaha Nebraska
| | - James Wall
- Levine Cancer Institute, Carolinas Healthcare System; Charlotte North Carolina
| | - Mark Tidswell
- Baystate Medical Center, Tufts University School of Medicine; Springfield Massachusetts
| | - Ernest DiNino
- Baystate Medical Center, Tufts University School of Medicine; Springfield Massachusetts
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