Class of hemorrhagic shock is associated with progressive diastolic coronary flow reversal and diminished left ventricular function

Noha N Elansary; David P Stonko; Rebecca N Treffalls; Hossam Abdou; Marta J Madurska; Jonathan J Morrison

doi:10.3389/fphys.2022.1033784

Class of hemorrhagic shock is associated with progressive diastolic coronary flow reversal and diminished left ventricular function

Front Physiol. 2022 Dec 14:13:1033784. doi: 10.3389/fphys.2022.1033784. eCollection 2022.

Authors

Noha N Elansary^{1

2}, David P Stonko², Rebecca N Treffalls¹, Hossam Abdou¹, Marta J Madurska¹, Jonathan J Morrison³

Affiliations

¹ R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, United States.
² Department of Surgery, University of Maryland Medical System, Baltimore, MD, United States.
³ Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, MN, United States.

Abstract

Introduction: The relationship between coronary artery flow and left ventricular (LV) function during hemorrhagic shock remains unknown. The aim of this study was to quantify coronary artery flow directionality alongside left ventricular function through the four classes of hemorrhage shock. Methods: Following baseline data collection, swine were exsanguinated into cardiac arrest via the femoral artery using a logarithmic bleed, taking each animal through the four classes of hemorrhagic shock based on percent bleed (class I: 15%; class II: 15%-30%; class III: 30%-40%; class IV: >40%). Telemetry data, left ventricular pressure-volume loops, and left anterior descending artery flow tracings over numerous cardiac cycles were collected and analyzed for each animal throughout. Results: Five male swine (mean 72 ± 12 kg) were successfully exsanguinated into cardiac arrest. Mean left ventricular end-diastolic volume, end-diastolic pressure, and stroke work decreased as the hemorrhagic shock class progressed (p < 0.001). The proportion of diastole spent with retrograde coronary flow was also associated with class of hemorrhagic shock (mean 5.6% of diastole in baseline, to 63.9% of diastole in class IV; p < 0.0001), worsening at each class from baseline through class IV. Preload recruitable stroke work (PRSW) decreased significantly in classes II through IV (p < 0.001). Systemic Vascular Resistance (SVR) is associated with class of hemorrhage shock (p < 0.001). Conclusion: With progressive classes of hemorrhagic shock left ventricular function progressively decreased, and the coronary arteries spent a greater proportion of diastole in retrograde flow, with progressively more negative total coronary flow. Preload recruitable stroke work, a load-independent measure of inotropy, also worsened in severe hemorrhagic shock, indicating the mechanism extends beyond the drop in preload and afterload alone.

Keywords: coronary artery flow; exsanguination cardiac arrest; hemorrhagic shock; left ventricular function (LV function); pressure-volume (P-V) loop.