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Fluid resuscitation for trauma patients: Does evidence support pre-hospital paramedic interventions?
Abstract   Peer reviewed

Fluid resuscitation for trauma patients: Does evidence support pre-hospital paramedic interventions?

Anthony McErvale
Australasian Journal of Paramedicine, Vol.14(1), p.13
Paramedics Australasia International Conference (PAIC), 2016 (Auckland, New Zealand, 17-Nov-2016–19-Nov-2016)
2017
DOI: https://doi.org/10.33151/ajp.14.1.555
url
https://doi.org/10.33151/ajp.14.1.555View
Published Version

Abstract

Public Health and Health Services
Introduction: Trauma is a significant cause of death and disability. Major haemorrhage is associated with significant mortality. Strategies to reduce mortality focus on reducing blood loss and increasing perfusion by restoring intravascular fluid volume. However, resuscitation fluids are associated with haemostatic disturbances. Consequently, complex pathologies result from the traumatic injury and fluid resuscitation. This report describes the evidence base for hypovolemic resuscitation ith an emphasis on prehospital settings and paramedic practice. Methods: Searches were performed of CINAHL, Scopus, PubMed and the Cochrane library. Search terms were: fluid resuscitation AND trauma AND pre-hospital, crystalloids VS colloids fluids, hypovolemic shock AND trauma. Date was limited to 2006-2016. The search yielded over 2000 abstracts and citations. Fourteen articles were selected based on relevance. A bias toward "pre-hospital resuscitation" was maintained. Results: Blood products are the pr ferred hospital resuscitation practice although this present logistical challenges for broader pre-hospital use. Although studies of traumatic brain injury have investigated resuscitation with hypertonic fluid, there is no evidence of benefit for hypertonic fluid to correct hypotension in the presence of TBI. In other injuries involving uncontrolled haemorrhage, permissive hypotension reduces the incidence of coagulopathy and hypothermia. Thus early small volume isotonic fluid administration is a recommend d strategy. Conclusion: Beyond surgical intervention there is no single panacea to treat hypovolemic shock thus present management strategies vary significantly. Moreover, consensus is divided on whether fluid resuscitation, in civilian trauma, should occur pre-hospital. More data is required to reduce variations in initial hypovolemic resuscitation management.

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