Remote ischemic preconditioning improves tissue oxygenation in a porcine model of controlled hemorrhage without fluid resuscitation

Gal Yaniv, Arik Eisenkraft*, Lilach Gavish, Linn Wagnert-Avraham, Dean Nachman, Jacob Megreli, Gil Shimon, Daniel Rimbrot, Ben Simon, Asaf Berman, Matan Cohen, David Kushnir, Ruth Shaylor, Baruch Batzofin, Shimon Firman, Amir Shlaifer, Michael Hartal, Yuval Heled, Elon Glassberg, Yitshak KreissS. David Gertz

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Remote ischemic preconditioning (RIPC) involves deliberate, brief interruptions of blood flow to increase the tolerance of distant critical organs to ischemia. This study tests the effects of limb RIPC in a porcine model of controlled hemorrhage without replacement therapy simulating an extreme field situation of delayed evacuation to definitive care. Twenty-eight pigs (47 ± 6 kg) were assigned to: (1) control, no procedure (n = 7); (2) HS = hemorrhagic shock (n = 13); and (3) RIPC + HS = remote ischemic preconditioning followed by hemorrhage (n = 8). The animals were observed for 7 h after bleeding without fluid replacement. Survival rate between animals of the RIPC + HS group and those of the HS group were similar (HS, 6 of 13[46%]-vs-RIPC + HS, 4 of 8[50%], p = 0.86 by Chi-square). Animals of the RIPC + HS group had faster recovery of mean arterial pressure and developed higher heart rates without complications. They also had less decrease in pH and bicarbonate, and the increase in lactate began later. Global oxygen delivery was higher, and tissue oxygen extraction ratio lower, in RIPC + HS animals. These improvements after RIPC in hemodynamic and metabolic status provide essential substrates for improved cellular response after hemorrhage and reduction of the likelihood of potentially catastrophic consequences of the accompanying ischemia.

Original languageAmerican English
Article number10808
JournalScientific Reports
Volume11
Issue number1
DOIs
StatePublished - 24 May 2021

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