Page 147 - Journal of Special Operations Medicine - Summer 2016

Fluid Resuscitation from Ideal Resuscitation Fluid
Hemorrhagic Shock

“The historic role of crystalloid and colloid solutions in Volume Hemostatic O2 Carrying
Capacity
trauma resuscitation represents the triumph of hope
and wishful thinking over physiology and Crystalloid Y N N
experience.”
LTC Andre Cap Colloid Y N N

J Trauma, 2015 Plasma Y Y N

There is an increasing awareness that fluid 1:1:1 Y Y Y
resuscitation for casualties in hemorrhagic shock is
best accomplished with fluid that is identical to that Whole Blood Y Y Y
lost by the casualty - whole blood.

TCCC Fluid Resuscitation fm Forrest Gump on Fluid
Hemorrhagic Shock: 2014 Resuscitation

Updated Fluid Resuscitation Plan
Order of precedence for fluid resuscitation of casualties
in hemorrhagic shock
1. Whole blood
2. 1:1:1 plasma:RBCs:platelets
3. 1:1 plasma and RBCs
4. (tie) Plasma (liquid, thawed, dried) or RBCs
alone
8. Hextend Slide: Dr
9. (tie) Lactated Ringers or Plasma-Lyte A Marty
Schreiber

Damage Control Titrating Fluid Resuscitation:
Resuscitation A Look Back: 1993

• 246 combat casualties with massive transfusions
• Mortality at hospital D/C by plasma to RBC ratio • Prehospital fluid resuscitation in 1993 per ATLS –
• Low ratio (1:8) – Mortality was 65% 2 liters of crystalloid (NS or LR)
• Medium ratio (1:2.5) – Mortality was 34% • TCCC recommendation: Titrate to improved level
• High ratio (1:1.4) – Mortality was 19%
• P < 0.001 of consciousness or palpable radial pulse
• Systolic BP of 80-90 mmHG; 90 or more in TBI

TCCC Updates 133