Administration of 25% albumin improves prehospital survivability in a preclinical rat model of decompensated hemorrhagic shock

Background Plasma has been used as an efficient resuscitation fluid to improve prehospital survival from hemorrhagic shock. The 25% albumin (25% ALB, w/v in aqueous diluent) is a hyperoncotic fluid, and we hypothesize that it can be used as a lower‐volume alternative to plasma in hypovolemic shock. Method Isoflurane‐anesthetized Sprague‐Dawley rats were subjected to a lethal decompensated hemorrhagic shock via removing 65% estimated blood volume (EBV, calculated by 6% body weight (gram) + 0.77 mL) of blood within 20 min. At 20 min post‐hemorrhage, rats randomly received plasma (20% EBV), 25% ALB (4% EBV), or respective vehicles, followed by fresh whole blood (FWB, 20% EBV) at 1 h post‐hemorrhage. The outcome was also compared between plasma and 25% ALB without FWB resuscitation in a separate experiment. Results 20% EBV of plasma or 4% EBV of 25% ALB led to 100% survival at 60 min from the start of hemorrhage, compared to zero survival without treatment. Survival was maintained at least 4 h following limited resuscitation, with or without FWB at 1 h post‐hemorrhage. The lack of fibrinogen in 25% ALB was notable and compromised the hemostatic outcome as compared to using plasma, which was partially restored by FWB resuscitation with the reduction in prothrombin time. Conclusion The current study indicates that 25% ALB enhances survival and maintains hemodynamics at only one‐fifth the volume of plasma. The results also suggest that 25% ALB requires hemostatic agents or subsequent blood products to counteract the hemostatic deficiency caused by hemodilution.