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Inconsistent evidence surrounds pre-hospital intravenous fluid therapy for major trauma. Crystalloids exhibit uncertainty, but high-ratio bloods hold early promise.
The following is a summary of “Volume replacement in the resuscitation of trauma patients with acute hemorrhage: an umbrella review,” published in the November 2023 issue of Emergency Medicine by Gianola et al.
The role of intravenous fluid therapy in pre-hospital care for major trauma patients remains a subject of ongoing controversy and critical examination.
Researchers conducted a retrospective study investigating the optimal volume expansion for hemorrhagic shock resuscitation, aiming to inform the formulation of evidence-based guidelines for managing major trauma.
They reviewed PubMed, Embase, and CENTRAL databases (September 2022) for systematic reviews (SRs) examining the impact of volume expansion fluids on mortality and survival. Quality assessment utilized AMSTAR 2, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
The result showed 14 systematic reviews on mortality outcomes comparing crystalloids, blood components, and whole blood. Most reviews were rated critically low and showed slight overlap in primary studies and consistent results. Crystalloids exhibited inconsistent evidence for 28- to 30-day survival, particularly with hypertonic saline/dextran compared to isotonic solutions, supported by moderate certainty. Pre-hospital blood component infusion suggested mortality reduction, but evidence certainty ranged from very low to moderate, hindering conclusive recommendations. Higher blood component ratios were favored across comparisons, with moderate to very low certainty. Whole blood effects remained uncertain due to limited and heterogeneous interventions in the reviewed studies.
Investigators concluded that crystalloids didn’t boost 28-30 day survival, but high-ratio bloods hold early promise, while whole blood needs more research.
Soure: intjem.biomedcentral.com/articles/10.1186/s12245-023-00563-4
