Emergency Department Crystalloid Resuscitation of 1.5 L or More is Associated With Increased Mortality in Elderly and Nonelderly Trauma Patients

Abstract

ED volume replacement of 1.5 L or more was an independent risk factor for mortality. High-volume resuscitations were associated with high-mortality particularly in the elderly trauma patient. Our finding supports the notion that excessive fluid resuscitation should be avoided in the ED and when required, operative intervention or intensive care admission should be considered.

In Vitro Hemostatic Properties of French Lyophilized Plasma

“…Various experimental and clinical data have provided evidence that the volume resuscitation with crystalloids or colloids can induce a coagulopathy characterized by a compromised clot development, whereas the initiation of coagulation is unaffected. 1,2 Thus, a large amount of data advocate for liberal and early use of plasma in a concept of "damage control resuscitation" [3][4][5] to manage massive hemorrhage. To foster these new guidelines and to deliver plasma earlier in the emergency setting, many centers are using thawed plasma for the resuscitation of major trauma.…”

Reanimación con fluidos y hemoderivados en trauma

“…Lo que sí está claro, es que el aporte de fluidos puede ser deletéreo durante la reanimación inicial del trauma. Estudios en urgencia 24 y en el pre hospitalario 25 han reportado que el aporte de cristaloides es un factor de riesgo independiente de la mortalidad. El efecto positivo de la resucitación hipotensora probablemente está dado por limitar el desarrollo de coagulopatía al evitar la hemodilución.…”

A Prospective, Randomized Investigation of Plasma First Resuscitation" for Traumatic Hemorrhage and Attenuation of the Acute Coagulopathy of Trauma"

“…Multiple studies now support restricted crystalloid resuscitation, and Ley et al 4 identified $1.5 L as being associated with increased mortality among 3000 trauma patients. Brohi et al's 5 often quoted 24.4% incidence of trauma-associated, acute coagulopathy on admission to the emergency department at a median of 73 minutes (interquartile range, 57-75) after injury involved patients who had all received <1,500 mL of prehospital crystalloid.…”