Ineffectiveness of Adreno-Cortical Preparations in Standardized Hemorrhagic Shock. ∗

Abstract

In our opinion, the prophylactic or curative action of adrenocortical preparations in shock has not been∗ tested under sufficiently controlled conditions, either experimentally or clinically. In order to do so experimentally, it is highly important to have a procedure by which irreversible shock can be produced simply and with reasonable constancy.

Standardized Hemorrhagic Shock. Having previously established that irreversible circulatory failure after extreme hemorrhage is conditioned not by the volume of blood lost, but by the degree and duration of the hypotension, Werle and Wiggers 1 recently surveyed 74 experiments and concluded that an initial period of moderate hypotension (ca. 50 mm Hg) lasting 90 min, followed by a subsequent period of drastic hypotension (ca. 30 mm) lasting 45 min, generally resulted in irreversible circulatory failure. They were not certain, however, that these represented minimal figures.

We have systematically explored this method, establishing a number of refinements in technic, and find that these represent about the minimal intervals which produces irreversible hemorrhagic shock in about 85% of dogs.

If adreno-cortical preparations are beneficial in shock, animals primed with these preparations and/or treated with them during the course of an experiment should better withstand such periods of moderate and drastic hypotension. Since reputed benefit is supposedly exerted on minute vessels, and since duodenal congestion and hemorrhage and subendocardial hemorrhages were the only observable evidences of possible capillary damage, it would also be anticipated that such changes would be prevented.

Since it was questionable as to which of the substances isolated from the adrenal cortex might prove potent, it seemed desirable to limit our studies to preparations of the whole cortex. Three preparations presumably potent in maintaining adrenalec-tomized dogs were used: (1) Parke Davis' experimental preparation containing 40 g of fresh cortex per cc (2) Dr. Kendall's preparation (735-736) containing 150 g of fresh cortex per cc and (3) an Upjohn Co. preparation containing 2.5 rat units per cc.