EFFECT OF IRRIGATION FLUID COMPOSITION ON HEMOSTASIS IN MOUSE BLEEDING MODELS

Introduction: Intraoperative irrigation, usually with normal saline (NS), aids in bleeding identification and management. We investigated the effect of different irrigation fluids, with additives, on hemostasis using two bleeding models. Methods: C57BL/6 J mice were subjected to a tail bleed model or uncontrolled abdominal hemorrhage via liver laceration followed by abdominal cavity irrigation. We compared NS, lactated Ringer's (LR), and PlasmaLyte. We examined NS and LR at different temperatures. Normal saline or LR with calcium (Ca2+) or tranexamic acid (TXA) was studied. Results: Compared with room temperature (RT), increasing the temperature of the irrigation fluid to 37 degrees C and 42 degrees C reduced tail vein bleeding times substantially in both NS and LR (all P < 0.001), with no significant differences between the two fluids. At RT, LR, but not PlasmaLyte, substantially reduced bleeding times in comparison to NS (P < 0.0001). Liver injury blood loss was lower with LR (P < 0.01). Normal saline supplemented with 2.7 mEq/L of Ca2+ decreased bleeding time and blood loss volume (P < 0.001 and P < 0.01, respectively) to similar levels as LR. Normal saline with 150 mg/mL of TXA markedly reduced bleeding time (P < 0.0001), and NS with 62.5 mg/mL TXA decreased blood loss (P < 0.01). Conclusion: Whereas Ca2+- and TXA-supplemented NS reduced bleeding, LR remained superior to all irrigation fluid compositions. As LR contains Ca2+, and Ca2+-supplemented NS mirrored LR in response, Ca2+ presence in the irrigation fluid seems key to improving solution's hemostatic ability. Because warming the fluids normalized the choice of agents, the data also suggest that Ca2+-containing fluids such as LR may be more suitable for hemostasis when used at RT.

Automated summary

The study found that lactated Ringer's (LR) was superior to normal saline (NS) and PlasmaLyte in achieving hemostasis during intraoperative irrigation. Warming the irrigation fluid significantly reduced bleeding time. Adding Ca2+ and tranexamic acid (TXA) to NS also reduced bleeding time and blood loss, but LR remained more effective.