TRAUMATIC SHOCK. XIII. THE PREVENTION OF IRREVERSIBILITY IN HEMORRHAGIC SHOCK BY VIVIPERFUSION OF THE LIVER 1

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Abstract
The maintenance of adequate blood flow through the liver while the remainder of the organism is subjected to the deficient blood flow or prolonged hemorrhagic shock protects the organism from developing irreversibility. Eleven of 12 dogs in hemorrhagic shock with a blood pressure of 30 mm. Hg, the livers of which received additional arterial blood by cross-circulation with healthy donor dogs, survived when transfused after a period of shock ordinarily long enough to render transfusion ineffective. Fifteen of 17 dogs similarly treated, except that the donor''s blood entered the jugular instead of the splenic vein, died after the transfusion. None of the donor dogs in either group died or showed any adverse effects from the cross-circulation procedure. With the perfected technique described, the liver-perfused dogs endured a hypotensive level of 30 mm. Hg for a much longer period of time than jugular-perfused dogs. In some of the liver-perfused dogs, evidence of damage to the central nervous system appeared late in the perfusion period, but this damage was transitory and disappeared after transfusion, except in isolated instances. Disturbances in intermediary metabolism were less marked in shocked dogs being vivi-perfused as compared to shocked dogs not perfused, but in an equally severe degree of hemorrhagic shock. There was no evidence, however, that survival of. the liver-perfused dogs bears any relation to the lessened degree of metabolic derangement. These observations indicate that loss of liver integrity is a significant factor in the collapse of the organism in advanced hemorrhagic shock and that the preservation of liver function is of crucial importance in recovery from advanced hemorrhagic shock. Anoxia of other organs or tissues, produced under the exptl. conditions, is not important in the development of irreversibility in hemorrhagic shock, since vivi-perfusion of the liver provided protection sufficient to produce survival while vivi-perfusion through the systemic veins does not. Whether maintenance of liver integrity protects by preventing secondary deterioration in other organs or tissues, it is not possible to say.

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