Trends in pre-hospital volume resuscitation of blunt trauma patients: a 15-year analysis of the British (TARN) and German (TraumaRegister DGU®) National Registries.
Crystalloids
Fluids
Outcomes
Resuscitation
Trauma
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
15 Mar 2024
15 Mar 2024
Historique:
received:
09
12
2023
accepted:
28
02
2024
medline:
18
3
2024
pubmed:
16
3
2024
entrez:
16
3
2024
Statut:
epublish
Résumé
Fluid resuscitation has long been a cornerstone of pre-hospital trauma care, yet its optimal approach remains undetermined. Although a liberal approach to fluid resuscitation has been linked with increased complications, the potential survival benefits of a restrictive approach in blunt trauma patients have not been definitively established. Consequently, equipoise persists regarding the optimal fluid resuscitation strategy in this population. We analysed data from the two largest European trauma registries, the UK Trauma Audit and Research Network (TARN) and the German TraumaRegister DGU® (TR-DGU), between 2004 and 2018. All adult blunt trauma patients with an Injury Severity Score > 15 were included. We examined annual trends in pre-hospital fluid resuscitation, admission coagulation function, and mortality rates. Over the 15-year study period, data from 68,510 patients in the TARN cohort and 82,551 patients in the TR-DGU cohort were analysed. In the TARN cohort, 3.4% patients received pre-hospital crystalloid fluids, with a median volume of 25 ml (20-36 ml) administered. Conversely, in the TR-DGU cohort, 91.1% patients received pre-hospital crystalloid fluids, with a median volume of 756 ml (750-912 ml) administered. Notably, both cohorts demonstrated a consistent year-on-year decrease in the volume of pre-hospital fluid administered, accompanied by improvements in admission coagulation function and reduced mortality rates. Considerable variability exists in pre-hospital fluid resuscitation strategies for blunt trauma patients. Our data suggest a trend towards reduced pre-hospital fluid administration over time. This trend appears to be associated with improved coagulation function and decreased mortality rates. However, we acknowledge that these outcomes are influenced by multiple factors, including other improvements in pre-hospital care over time. Future research should aim to identify which trauma populations may benefit, be harmed, or remain unaffected by different pre-hospital fluid resuscitation strategies.
Identifiants
pubmed: 38491444
doi: 10.1186/s13054-024-04854-x
pii: 10.1186/s13054-024-04854-x
doi:
Substances chimiques
Crystalloid Solutions
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
81Informations de copyright
© 2024. The Author(s).
Références
Cotton BA, Jerome R, Collier BR, Khetarpal S, Holevar M, Tucker B, et al. Guidelines for prehospital fluid resuscitation in the injured patient. J Trauma. 2009;67(2):389–402.
pubmed: 19667896
NICE Guidance. Pre-hospital initiation of fluid replacement therapy in trauma. 2004 Jan.
Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, et al. Trauma-induced coagulopathy. Nat Rev Dis Primers. 2021;7(1):30.
doi: 10.1038/s41572-021-00264-3
pubmed: 33927200
pmcid: 9107773
Callcut RA, Kornblith LZ, Conroy AS, Robles AJ, Meizoso JP, Namias N, et al. The why and how our trauma patients die: a prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg. 2019;86(5):864–70.
doi: 10.1097/TA.0000000000002205
pubmed: 30633095
pmcid: 6754176
Søreide K, Krüger AJ, Vårdal AL, Ellingsen CL, Søreide E, Lossius HM. Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace. Older Face World J Surg. 2007;31(11):2092–103.
doi: 10.1007/s00268-007-9226-9
pubmed: 17899256
Evans JA, van Wessem KJP, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010;34(1):158–63.
doi: 10.1007/s00268-009-0266-1
pubmed: 19882185
CRASH-2 collaborators. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096–11012.
doi: 10.1016/S0140-6736(11)60278-X
Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018;378(4):370–9.
doi: 10.1056/NEJMra1705649
pubmed: 29365303
Revell M, Porter K, Greaves I. Fluid resuscitation in prehospital trauma care: a consensus view. Emerg Med J. 2002;19(6):494–8.
doi: 10.1136/emj.19.6.494
pubmed: 12421770
pmcid: 1756310
Cannon W, Cowell E. The preventive treatment of wound shock. JAMA. 1918;70:618–21.
Wiggers CJ. Experimental hemorrhage shock. In: Physiology of shock. New York: The Commonwealth Fund; 1950. p. 121–43.
Moore FD, Shires G. Moderation. Ann Surg. 1967;166(2):300–1.
pubmed: 6029581
pmcid: 1477384
Rabinovici R, Krausz MM, Feuerstein G. Control of bleeding is essential for a successful treatment of hemorrhagic shock with 7.5 per cent sodium chloride solution. Surg Gynecol Obstet. 1991;173(2):98–106.
pubmed: 1925873
Krausz MM, Bar-Ziv M, Rabinovici R, Gross D. “Scoop and run” or stabilize hemorrhagic shock with normal saline or small-volume hypertonic saline? J Trauma. 1992;33(1):6–10.
doi: 10.1097/00005373-199207000-00002
pubmed: 1635107
Capone A, Safar P, Stezoski SW, Peitzman A, Tisherman S. Uncontrolled hemorrhagic shock outcome model in rats. Resuscitation. 1995;29(2):143–52.
doi: 10.1016/0300-9572(95)00829-I
pubmed: 7659867
Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331(17):1105–9.
doi: 10.1056/NEJM199410273311701
pubmed: 7935634
Cotton BA, Guy JS, Morris JA, Abumrad NN. The cellular, metabolic, and systemic consequences of aggressive fluid resuscitation strategies. Shock. 2006;26(2):115–21.
doi: 10.1097/01.shk.0000209564.84822.f2
pubmed: 16878017
Kasotakis G, Sideris A, Yang Y, de Moya M, Alam H, King DR, et al. Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database. J Trauma Acute Care Surg. 2013;74(5):1215–21.
pubmed: 23609270
pmcid: 3984883
Hébert S, Kohtakangas E, Campbell A, Ohle R. The efficacy of prehospital IV fluid management in severely injured adult trauma patients: a systematic review and meta-analysis. CJEM. 2023;25(3):200–8.
doi: 10.1007/s43678-023-00447-9
pubmed: 36735147
Deeb AP, Lu L, Guyette FX, Peitzman AB, Daley BJ, Miller RS, et al. Optimal prehospital crystalloid resuscitation volume in trauma patients at risk for hemorrhagic shock. J Am Coll Surg. 2023;1237(2):183–94.
doi: 10.1097/XCS.0000000000000695
Al-Shaqsi S. Models of international emergency medical service (EMS) systems. Oman Med J. 2010;25(4):320–3.
pubmed: 22043368
pmcid: 3191661
Strobel J, McIntyre I, Griffiths D, Savinsky G, Hemmi T, Tries R. Advanced Paramedic Practitioner—eine Lösung für die Herausforderungen im deutschen Rettungsdienst? Notfall + Rettungsmedizin. 2024 Jan 24.
Deutsche Gesellschaft für Unfallchirurgie. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung (AWMF Registernummer 187-023) [Internet]. 2022. Available from: https://www.awmf.org/leitlinien/detail/ll/187-023.html
Trauma Audit and Research Network. https://www.tarn.ac.uk/ . 2022.
TraumaRegister DGU. https://www.traumaregister-dgu.de/ . 2022.
Davenport R, Manson J, Death H, Platton S, Coates A, Allard S, et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med. 2011;39(12):2652.
doi: 10.1097/CCM.0b013e3182281af5
pubmed: 21765358
pmcid: 3223409
American College of Surgeons. Advanced Trauma Life Support (ATLS) Student Course Manual. 10th ed. 2018.
Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54(6):1127–30.
doi: 10.1097/01.TA.0000069184.82147.06
pubmed: 12813333
Hampton DA, Fabricant LJ, Differding J, Diggs B, Underwood S, De La Cruz D, et al. Prehospital intravenous fluid is associated with increased survival in trauma patients. J Trauma Acute Care Surg. 2013;75(1 Suppl 1):S9-15.
doi: 10.1097/TA.0b013e318290cd52
pubmed: 23778518
pmcid: 3744192
Schreiber MA, Meier EN, Tisherman SA, Kerby JD, Newgard CD, Brasel K, et al. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: results of a prospective randomized pilot trial. J Trauma Acute Care Surg. 2015;78(4):687–95; discussion 695-7.
Kutcher ME, Howard BM, Sperry JL, Hubbard AE, Decker AL, Cuschieri J, et al. Evolving beyond the vicious triad: differential mediation of traumatic coagulopathy by injury, shock, and resuscitation. J Trauma Acute Care Surg. 2015;78(3):516–23.
doi: 10.1097/TA.0000000000000545
pubmed: 25710421
Moore HB, Moore EE, Gonzalez E, Wiener G, Chapman MP, Dzieciatkowska M, et al. Plasma is the physiologic buffer of tissue plasminogen activator-mediated fibrinolysis: rationale for plasma-first resuscitation after life-threatening hemorrhage. J Am Coll Surg. 2015;220(5):872–9.
doi: 10.1016/j.jamcollsurg.2015.01.026
pubmed: 25840538
pmcid: 4409505
Berg S, Golster M, Lisander B. Albumin extravasation and tissue washout of hyaluronan after plasma volume expansion with crystalloid or hypooncotic colloid solutions. Acta Anaesthesiol Scand. 2002;46(2):166–72.
doi: 10.1034/j.1399-6576.2002.460207.x
pubmed: 11942864
Weykamp MB, Stern K, Brakenridge SC, Robinson BR, Wade CE, Fox EE, et al. Prehospital crystalloid resuscitation: practice variation and associations with clinical outcomes. Shock. 2023;59(1):28–33.
pubmed: 36703275
Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, et al. Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury. 2007;38(3):298–304.
doi: 10.1016/j.injury.2006.10.003
pubmed: 17214989
Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369(13):1243–51.
doi: 10.1056/NEJMra1208627
pubmed: 24066745
Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367(20):1901–11.
doi: 10.1056/NEJMoa1209759
pubmed: 23075127
Holcomb JB, del Junco DJ, Fox EE, Wade CE, Cohen MJ, Schreiber MA, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study. JAMA Surg. 2013;148(2):127.
doi: 10.1001/2013.jamasurg.387
pubmed: 23560283
pmcid: 3740072
Dolu H, Schwartz A. Prähospitale Gabe von Blut und Blutprodukten im zivilen und militärischen Setting. Wehrmed Monatsschr. 2021;65(11):407–18.
Rudolph M, Sitzmann N, Braun J, Henkel B, Reifferscheid F. Präklinische therapie mit blutprodukten – das projekt “heliblut.” Notarzt. 2021;37(06):319–24.
doi: 10.1055/a-1546-1374
Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma. JAMA. 2015;313(5):471.
doi: 10.1001/jama.2015.12
pubmed: 25647203
pmcid: 4374744
Crombie N, Doughty HA, Bishop JRB, Desai A, Dixon EF, Hancox JM, et al. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Haematol. 2022;9(4):e250–61.
doi: 10.1016/S2352-3026(22)00040-0
pubmed: 35271808
pmcid: 8960285