Resuscitation of an exsanguinated obstetrics patient with HBOC‐201: A case report. (24th June 2022)

• Record Type: Journal Article
• Authors: Barrett, Christopher D.; Theodore, Sheina; Dechert, Tracey; Burke, Peter; Khoury, Rasha; Cap, Andrew P.; Scantling, Dane
• Other Names: Yazer Mark H. guestEditor.; Watts Sarah A. guestEditor.; Woolley Col Tom guestEditor.
• Is Part Of: Transfusion. Volume 62(2022)Supplement 1
• Page Start: S218
• Page End: S223
• Publication Date: 2022-06-24
• Subjects: bleeding -- exsanguination -- HBOC‐201 -- resuscitation; Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.16973
• Languages: English
• ISSNs: 0041-1132

Abstract

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.