Prehospital intravenous fluid is associated with increased survival in trauma patients. J Trauma Acute Care Surg 2013 Jul;75(1 Suppl 1):S9-15
Date
08/13/2013Pubmed ID
23778518Pubmed Central ID
PMC3744192DOI
10.1097/TA.0b013e318290cd52Scopus ID
2-s2.0-84880439593 (requires institutional sign-in at Scopus site) 70 CitationsAbstract
BACKGROUND: Delivery of intravenous crystalloid fluids (IVF) remains a tradition-based priority during prehospital resuscitation of trauma patients. Hypotensive and targeted resuscitation algorithms have been shown to improve patient outcomes. We hypothesized that receiving any prehospital IVF is associated with increased survival in trauma patients compared with receiving no prehospital IVF.
METHODS: Prospective data from 10 Level 1 trauma centers were collected. Patient demographics, prehospital IVF volume, prehospital and emergency department vital signs, lifesaving interventions, laboratory values, outcomes, and complications were collected and analyzed. Patients who did or did not receive prehospital IVF were compared. Tests for nonparametric data were used to assess significant differences between groups (p ≤ 0.05). Cox regression analyses were performed to determine the independent influence of IVF on outcome and complications.
RESULTS: The study population consisted of 1,245 trauma patients; 45 were excluded owing to incomplete data; 84% (n = 1,009) received prehospital IVF, and 16% (n = 191) did not. There was no difference between the groups with respect to sex, age, and Injury Severity Score (ISS). The on-scene systolic blood pressure was lower in the IVF group (110 mm Hg vs. 100 mm Hg, p < 0.04) and did not change significantly after IVF, measured at emergency department admission (110 mm Hg vs. 105 mm Hg, p = 0.05). Hematocrit/hemoglobin, fibrinogen, and platelets were lower (p < 0.05), and prothrombin time/international normalized ratio and partial thromboplastin time were higher (p < 0.001) in the IVF group. The IVF group received a median fluid volume of 700 mL (interquartile range, 300-1,300). The Cox regression revealed that prehospital fluid administration was associated with increased survival (hazard ratio, 0.84; 95% confidence interval, 0.72-0.98; p = 0.03). Site differences in ISS and fluid volumes were demonstrated (p < 0.001).
CONCLUSION: Prehospital IVF volumes commonly used by PRospective Observational Multicenter Massive Transfusion Study (PROMMTT) investigators do not result in increased systolic blood pressure but are associated with decreased in-hospital mortality in trauma patients compared with patients who did not receive prehospital IVF.
Author List
Hampton DA, Fabricant LJ, Differding J, Diggs B, Underwood S, De La Cruz D, Holcomb JB, Brasel KJ, Cohen MJ, Fox EE, Alarcon LH, Rahbar MH, Phelan HA, Bulger EM, Muskat P, Myers JG, del Junco DJ, Wade CE, Cotton BA, Schreiber MA, PROMMTT Study GroupMESH terms used to index this publication - Major topics in bold
AdultChi-Square Distribution
Emergency Medical Services
Female
Fluid Therapy
Humans
Injury Severity Score
Isotonic Solutions
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Resuscitation
Statistics, Nonparametric
Survival Rate
Trauma Centers
United States
Wounds and Injuries
