Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: An analysis of the Glue Grant database

Kasotakis, George; Sideris, Antonios C.; Yang, Yuchiao; Moya, Marc de; Alam, Hasan B.; King, David R.; Tompkins, Ronald G.; Velmahos, George C.

doi:10.1097/01586154-201305000-00005

Cited by 50 publications

(78 citation statements)

References 36 publications

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“…this use of plasma is based on data indicating an association between the initiation of earlier plasma transfusion in the hospital setting and positive patient outcomes (18,28), as well as evidence of deleterious effects of crystalloids of colloids as primary resuscitation fluids (29). the beneficial effect of plasma resuscitation is likely due to the avoidance of dilutional coagulopathy, the replacement of both proand anticoagulant proteins, the repair of endothelial function, and the promotion of anti-inflammatory effects (30).…”

Section: Fdpmentioning

confidence: 99%

A Decade of Advances in Military Trauma Care

et al. 2014

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Background: While combat casualty care shares many key concepts with civilian trauma systems, its unique features mandate certain practices that are distinct from the civilian ones. Methods: This is a review of the most current literature on combat casualty care, based on computer database searches for studies on combat casualty care and military medicine. Studies were selected for inclusion in this review based on their relevance and contribution. Results: Over the last decade, meticulous, international data collection and research efforts have led to significant improvements in military trauma care. Combat medicine has focused on the causes of preventable deaths and targeted on bleeding control and resuscitation strategies, as well as improved evacuation. En route care and forward surgical interventions have resulted in unprecedented low fatality rates and the saving of more lives. Conclusion: This overview of the developments in combat casualty care in recent years emphasizes medical practices that are characteristic of combat medicine, yet with the potential to save lives in other scenarios, as well.

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Section: Fdpmentioning

confidence: 99%

A Decade of Advances in Military Trauma Care

et al. 2014

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“…42 This association has been called crystalloid-associated lung injury and the deleterious effects of crystalloid infusion are becoming more widely recognized. 30 43 This new definition includes a clinically relevant rate of transfusion and includes the majority of patients who rapidly exsanguinate. By optimally defining the patient population to be studied and designing the studies to answer relevant questions, this field will move forward.…”

mentioning

confidence: 99%

“…The infusion of crystalloid has shown to result in deleterious interstitial edema, ARDS, and multiple organ failure. 30 Resuscitating with plasma appears to help repair the "endotheliopathy" of injury, minimizing edema and avoiding the iatrogenic resuscitation injury associated with excessive crystalloid and unbalanced blood product administration.…”

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confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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“…aggressive fluid resuscitation results in worse coagulopathy, an exaggerated trauma-related systemic inflammatory response syndrome (SIrS), an increased incidence of adult respiratory distress syndrome (ardS), pulmonary edema, compartment syndrome, anemia, thrombocytopenia, pneumonia, electrolyte disturbances, and overall worse survival (27)(28)(29)(30)(31)(32).…”

Section: Restrictive Fluid Administrationmentioning

confidence: 99%

Damage Control Resuscitation In Trauma

Kaafarani

Velmahos

2014

Scand J Surg

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Introduction: most preventable trauma deaths are due to uncontrolled hemorrhage.Methods: in this article, we briefly describe the pathophysiology of the classical triad of death in trauma, namely, acidosis, hypothermia, and coagulopathy, and then suggest damage control resuscitation strategies to prevent and/or mitigate the effects of each in the bleeding patient.Results: Damage control resuscitation strategies include body rewarming, restrictive fluid administration, permissive hypotension, balanced blood product administration, and the implementation of massive transfusion protocols.Conclusion: resuscitating and correcting the coagulopathy of the exsanguinating trauma patient is essential to improve chances of survival.

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Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: An analysis of the Glue Grant database

Abstract: Background-Evidence suggests that aggressive crystalloid resuscitation is associated with significant morbidity in various clinical settings. We wanted to assess whether aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients.

Cited by 50 publications

References 36 publications

A Decade of Advances in Military Trauma Care

A Decade of Advances in Military Trauma Care

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Damage Control Resuscitation In Trauma

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