Transfusion efficacy of novel anticoagulant-preservative solution in a rat model of decompensated hemorrhagic shock.

BACKGROUND

Hemorrhagic shock remains a leading cause of preventable death. Whole blood (WB) transfusion provides comprehensive resuscitation but is limited by storage-related degradation under standard refrigerated citrate-phosphate-dextrose-adenine (CPDA-1) conditions. A novel additive solution (APEX) was designed to mitigate storage lesions and extend WB functionality. This study evaluated the hemostatic preservation and resuscitative efficacy of APEX-stored WB in a rat model of decompensated hemorrhagic shock.

STUDY DESIGN AND

METHODS

WB was collected from anesthetized donor rats into CPDA-1 or CPDA-1 + APEX (7:5 ratio) and stored refrigerated (1-6°C) for 14 days. Recipient rats underwent a fixed-volume (65% estimated blood volume) hemorrhage followed by resuscitation with stored WB. Physiologic recovery, hemostatic function (rotational thromboelastometry [ROTEM]), and metabolic parameters were assessed over 120 min post-hemorrhage.

RESULTS

APEX-stored WB maintained comparable platelet and leukocyte counts and hemostatic indices to CPDA-1 WB after 14 days. Rats resuscitated with APEX WB showed improved metabolic recovery over CPDA-1, exhibiting significantly lower lactate (p = .022) and higher glucose (p = .021) levels at 120 min post-hemorrhage. Coagulation parameters (obtained by ROTEM) remained near baseline in APEX-treated animals, whereas CPDA-1 WB induced a hypercoagulable, fibrinolytic profile. A modest increase in lung wet/dry ratio was observed in the APEX group, with no intestinal edema.

DISCUSSION: In this preclinical model, we observed that APEX additive solution preserved rat WB quality and supported superior physiological recovery compared with standard CPDA-1 storage. These pilot findings support further investigation of APEX as an alternative WB storage technology.