Universität zu Köln

Driessen, Arne, Froehlich, Matthias, Schaefer, Nadine, Mutschler, Manuel, Defosse, Jerome M., Brockamp, Thomas, Bouillon, Bertil, Stuermer, Ewa K., Lefering, Rolf and Maegele, Marc (2016). Prehospital volume resuscitation - Did evidence defeat the crystalloid dogma? An analysis of the TraumaRegister DGU (R) 2002-2012. Scand. J. Trauma Resusc. Emerg. Med., 24. LONDON: BMC. ISSN 1757-7241

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Abstract

Background: Various studies have shown the deleterious effect of high volume resuscitation following severe trauma promoting coagulopathy by haemodilution, acidosis and hypothermia. As the optimal resuscitation strategy during prehospital trauma care is still discussed, we raised the question if the amount and kind of fluids administered changed over the recent years. Further, if less volume was administered, fewer patients should have arrived in coagulopathic depletion in the Emergency Department resulting in less blood product transfusions. Methods: A data analysis of the 100 489 patients entered into the TraumaRegister DGU (R) (TR-DGU) between 2002 and 2012 was performed of which a total of 23512 patients (23.3 %) matched the inclusion criteria. Volume and type of fluids administered as well as outcome parameter were analysed. Results: Between 2002 and 2012, the amount of volume administered during prehospital trauma care decreased from 1790 ml in 2002 to 1039 ml in 2012. At the same time higher haemoglobin mean values, higher Quick's mean values and reduced mean aPTT can be observed. Simultaneously, more patients received catecholamines (2002: 9.2 to 2012: 13.0 %). Interestingly, the amount of volume administered decreased steadily regardless of the presence of shock. Fewer patients were in the need of blood products and the number of massive transfusions (>= 10 pRBC) more than halved. Discussion: The changes in volume therapy might have reduced haemodilution potentially resulting in an increase of the Hb value. During the period observed transfusion strategies have become more restrictiveand ratio based; the percentage of patients receiving MT halved as blood products may imply negative secondary effects. Furthermore, preventing administration of high blood product ratios result in less impairment of coagulation factors and inhibitors and an therfore improved coagulation. Conclusion: The volume administered in severely injured patients decreased considerably during the last decade possibly supporting beneficial effects such as minimizing the risk of coagulopathy and avoiding potential harmful effects caused by blood product transfusions. Despite outstanding questions in trauma resuscitation, principle evidence merges quickly into clinical practice and algorithms.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Driessen, Arne UNSPECIFIED UNSPECIFIED UNSPECIFIED Froehlich, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Nadine UNSPECIFIED UNSPECIFIED UNSPECIFIED Mutschler, Manuel UNSPECIFIED UNSPECIFIED UNSPECIFIED Defosse, Jerome M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brockamp, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouillon, Bertil UNSPECIFIED UNSPECIFIED UNSPECIFIED Stuermer, Ewa K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lefering, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Maegele, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-278844
DOI:	10.1186/s13049-016-0233-4
Journal or Publication Title:	Scand. J. Trauma Resusc. Emerg. Med.
Volume:	24
Date:	2016
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1757-7241
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language HYPOTENSIVE TRAUMA PATIENTS; FLUID RESUSCITATION; HYDROXYETHYL STARCH; INCREASED MORTALITY; EARLY COAGULOPATHY; HEMORRHAGIC-SHOCK; INJURY; TRANSFUSION; MANAGEMENT; NOREPINEPHRINE Multiple languages Emergency Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27884