Page 148 - Journal of Special Operations Medicine - Summer 2016
P. 148
Blood Pressure and
Rebleeding – J Trauma 2003
• Prospective RCT; community consent obtained
• Aggressive early crystalloid resuscitation vs resuscitation • 70 swine with 1.5, 2.0. or 2.8 mm aortic punch
delayed until after repair of vascular injury • Resuscitation was with LR after 5-30 min delay
• Penetrating torso trauma; systolic BP < 90 mmHg • 5 animals died before fluid resuscitation
• Early n = 309; Delayed n = 289 • 3 died at onset of fluid resuscitation
• Volume: Early = 2,478 mL; Delayed = 375 mL • For remaining 62 animals, rebleeding occurred 83
at mean SBP of 94; MAP of 64
• Survival: Early = 62%; Delayed = 70% (p=0.04)
Crystalloids in Trauma Restrictive Fluid Resuscitation
Patients – J Trauma 2011 Duke – J Trauma - 2012
• Retrospective study – 3,137 patients
• Subgroups: 1, 1.5, 2, and 3 liters • 307 trauma patients - retrospective study
• Overall mortality 5.2%; elderly 17.3%; non 4% • Penetrating torso injury; SBP < 90
• Did not specify which crystalloid • RFR = Less than 150 mL of crystalloid prior to
• “ED volume replacement of 1.5 L or more was an damage control surgery (DCS) (n=132)
independent risk factor for mortality.” 84 • SFR = 150 mL or more prior to DCS (n=175) 85
Restrictive Fluid Resuscitation 28 January 2016
Duke – J Trauma - 2012 Somewhere in Theater
• 2 GSW to the chest – entered above the chest plates
• 2+ liters of blood from chest tube
• Resuscitated with thawed FFP, freeze-dried plasma,
and PRBCs
• “Not a drop of crystalloid”
• Pre-op crystalloid: RFR mean = 129 mL • Ketamine for pain – no opioids
• Pre-op crystalloid: SFR mean = 2757 mL • Found at surgery to have a right pulmonary vein
• RFR intra-op mortality 9%; SFR mortality 32% injury
• P = 0.001 86 • Arrested on the table – revived successfully
• Survived and doing well
134 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016
