Is There a Place for Crystalloids and Colloids in Remote Damage Control Resuscitation?

Abstract

Crystalloids and colloids are used in prehospital fluid resuscitation to replace blood loss and preserve tissue perfusion until definite surgical control of bleeding can be achieved. However, large volumes of fluids will increase bleeding by elevating blood pressure, dislodging blood clots, and diluting coagulation factors and platelets. Hypotensive fluid resuscitation strategies are used to avoid worsening of uncontrolled bleeding. This is largely supported by animal studies. Most clinical evidence suggests that restricting fluid therapy is associated with improved outcome. Remote damage control resuscitation emphasizes the early use of blood products and restriction of other fluids to support coagulation and tissue oxygenation. Controversy regarding the optimal choice and composition of resuscitation fluids is ongoing. Compared with crystalloids, less colloid is needed for the same expansion of intravascular volume. On the other hand, colloids may cause coagulopathy not only related to dilution. The most important advantage of using colloids is logistical because less volume and weight are needed. In conclusion, prehospital fluid resuscitation is considered the standard of care, but there is little clinical evidence supporting the use of either crystalloids or colloids in remote damage control resuscitation. Alternative resuscitation fluids are needed.

Markers for blood-brain barrier integrity: how appropriate is Evans blue in the twenty-first century and what are the alternatives?

“…Proper discussion of this is outside the scope of this review. Suffice it to say that the use of dextrans clinically is limited by a significant incidence of anaphylactoid reactions (Lundsgaard-Hansen, 1969 ; Medby, 2014 ) and coagulopathy due to interference with some of the clotting factors (Hahn, 2013 ; Medby, 2014 ) although this property has been put to good use in prevention and treatment of deep vein thrombosis (Medby, 2014 ). In animal experiments it was shown that release of histamine and 5-hydroxytryptamine occurs from mast cell degranulation as also reported for HRP (see above).…”

Obesity and Critical Illness

“…The most commonly used resuscitation fluids have been blood, saline, or lactated Ringer’s, but colloids have also been used. There is active clinical discussion about the merits and detriments of each fluid type and also about when and how much resuscitation is ideal (55). Other important protocol issues include the presence or absence of anesthesia, which can affect hemodynamic, neurological, and other physiological responses, as well as the use of anticoagulants such as heparin (Table 3) (49).…”

The Traumatic Hemostasis and Oxygenation Research Network Remote Damage Control Resuscitation (RDCR) Symposium

“…Medby (7), Norwegian Armed Forces Medical Services, provides a balanced overview of the current status and understanding of the benefits and risks of both crystalloids and colloids. Medby (7), Norwegian Armed Forces Medical Services, provides a balanced overview of the current status and understanding of the benefits and risks of both crystalloids and colloids.…”