Hypotensive Resuscitation of Casualties in the Far-forward Combat Environment: Effects of Select Crystalloids and Colloids on Signal Transduction Mediators in a Swine Model of Severe Hemorrhage

Hemorrhage remains a major cause of death on the battlefield in conventional warfare (Bellamy, 1984). Current dogma dictates that early, adequate fluid resuscitation is crucial to reduce the mortality and morbidity associated with hemorrhagic shock. Yet, despite much research in the field and years of resuscitating thousands of patients, the optimal fluid and resuscitation strategy for the treatment of hemorrhagic hypovolemia remains unknown. However, with future combat strategies focused around the Future Force Warrior, greater dispersal of troops and fighting in urban settings and on non-linear battlefields, the likelihood of longer evacuation times for combat casualties is anticipated. As a consequence of these conditions and the logistic limitations of weight and cube, fluid resuscitation research within the Army’s Combat Casualty Care Research Program has focused to investigate limitedor small-volume fluid resuscitation strategies, including permissive hypotension, in farforward areas for the treatment of severe hemorrhage. The ultimate goals are to improve battlefield survival and to reduce or prevent early and late deleterious sequelae in the injured soldier. For the military the concept of hypotensive resuscitation, or fluid resuscitation to a blood pressure below pre-hemorrhage levels, currently seems to be a rational approach to compensate for the limited amount of fluid available on the battlefield to treat casualties, and to minimize the chance for rebleeding from penetrating injuries. In addition, studies in experimental animals have suggested that hypotensive resuscitation may improve survival from an uncontrolled hemorrhage (Capone et al, 1995; Stern et al, 2001).