Early administration of hypertonic-hyperoncotic hydroxyethyl starch (HyperHES) improves cerebral blood flow and outcome after experimental subarachnoid hemorrhage in rats.

Early administration of hypertonic-hyperoncotic hydroxyethyl starch (HyperHES) improves cerebral blood flow and outcome after experimental subarachnoid hemorrhage in rats.

World Neurosurg. 2018 Apr 05;:

Authors: Lilla N, Rinne C, Weiland J, Linsenmann T, Westermaier T

Abstract
OBJECTIVE: Early cytotoxic brain edema may be one decisive factor which maintains a vicious of cerebral malperfusion after subarachnoid hemorrhage (SAH). In addition, endothelial cell swelling may be an independent factor restricting cerebral blood flow (CBF) in a very early stage after SAH. Immediate and aggressive treatment may be able to restore CBF in this critical period.
MATERIALS AND METHODS: Male Sprague-Dawley rats were subjected to SAH by the endovascular filament model and treated by a bolus of hyperoncotic-hypertonic hydroxyethyl starch (HyperHES 4 ml/kg body weight) immediately after vessel perforation and 150 min later (n = 12) or by the same amount of normal saline (n = 9). Mean arterial blood pressure (MABP), intracranial pressure (ICP), and local cerebral blood flow (LCBF) over both hemispheres were continuously measured by laser-Doppler flowmetry (LDF). Neurological assessment was performed 24 hours later. Hippocampal damage was assessed by H.E. - and Caspase-3 staining.
RESULTS: Arterial blood gases and MABP were not significantly different between the two groups. ICP was significantly reduced in the treatment group (p < 0.05). LCBF was significantly improved in the treatment group over both hemispheres (p < 0.05; 180 min after treatment p < 0.01). There was a trend to better neurological performance in the treatment group. The rate of injured neurons was significantly reduced in animals of the treatment group compared to controls (p < 0.01). The number of Caspase 3 positive neurons in the hippocampal CA1-field was not reduced.
CONCLUSION: In this study, the effects of very early and repeated treatment with a high-dose HyperHES were investigated. The results of this series show that this therapy can be highly effective to improve CBF and attenuate hippocampal cell damage in the early stage of SAH. Whether delayed cell death could be treated by longer therapy, cannot be answered by this study. Since no differential diagnosis to the clinical suspicion of SAH prohibits the administration of hypertonic-hyperoncotic solutions, it may be useful as a first-tier preclinical therapy in suspected SAH and could even be used by emergency rescue services before the patient is admitted to a hospital.

PMID: 29627628 [PubMed - as supplied by publisher]

https://ift.tt/2EwkUPG