Resuscitation after Uncontrolled Venous Hemorrhage

Smaïl, Nadia; Wang, Haichao; Cioffi, William G.; Bland, Kirby I.; Chaudry, Irshad H.

doi:10.1097/00005373-199804000-00026

Cited by 38 publications

(5 citation statements)

References 23 publications

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“…According to French pre-hospital guidelines, a saline or colloid solution may be used for all patients on-scene with different blood pressure targets depending on whether patients have neurological injury or not. This early therapy in blunt trauma aims to limit excess fluid loading and later risks of multiple organ failure, acute lung injury and haematological complications [20]. In the FIRST study, around 47% of patients received colloid solution.…”

Section: Discussionmentioning

confidence: 99%

Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

et al. 2011

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Introduction Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. Methods The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality. Results Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results. Conclusions This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies.

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Section: Discussionmentioning

confidence: 99%

Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

et al. 2011

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“…It was initially described in 1967 with radioactive microspheres, and has been validated by several investigators [24,25,39]. Because of legislation requirements, higher costs, and special care for the disposal and manipulation of radioactive material, non-radioactive microspheres were developed [21-24].…”

Section: Discussionmentioning

confidence: 99%

“…Although that finding could be attributed to a temporary compensatory response of the cardiovascular system, Smail et al report transient increased cardiac output in resuscitated animals compared to no resuscitation using radioactive microspheres 1.5 hours after the completion of resuscitation [25]. They also showed that increasing the resuscitation volume did not result in improved hemodynamics or organ perfusion [25]. Our results support that finding by the absence of significant difference in lactic acid levels in PH resuscitated animals compared to NBP resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study with radioactive microspheres moderate volume resuscitation improved organ perfusion with less bleeding after venous hemorrhage compared to large volume or no volume [25]. In that study, the interventions were not designed to simulate a real trauma scenario, and the resuscitation regimen used was not pressure guided [25].…”

Section: Introductionmentioning

confidence: 99%

“…In that study, the interventions were not designed to simulate a real trauma scenario, and the resuscitation regimen used was not pressure guided [25]. …”

Section: Introductionmentioning

confidence: 99%

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Permissive hypotension does not reduce regional organ perfusion compared to normotensive resuscitation: animal study with fluorescent microspheres

et al. 2012

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IntroductionThe objective of this study was to investigate regional organ perfusion acutely following uncontrolled hemorrhage in an animal model that simulates a penetrating vascular injury and accounts for prehospital times in urban trauma. We set forth to determine if hypotensive resuscitation (permissive hypotension) would result in equivalent organ perfusion compared to normotensive resuscitation.MethodsTwenty four (n=24) male rats randomized to 4 groups: Sham, No Fluid (NF), Permissive Hypotension (PH) (60% of baseline mean arterial pressure - MAP), Normotensive Resuscitation (NBP). Uncontrolled hemorrhage caused by a standardised injury to the abdominal aorta; MAP was monitored continuously and lactated Ringer’s was infused. Fluorimeter readings of regional blood flow of the brain, heart, lung, kidney, liver, and bowel were obtained at baseline and 85 minutes after hemorrhage, as well as, cardiac output, lactic acid, and laboratory tests; intra-abdominal blood loss was assessed. Analysis of variance was used for comparison.ResultsIntra-abdominal blood loss was higher in NBP group, as well as, lower hematocrit and hemoglobin levels. No statistical differences in perfusion of any organ between PH and NBP groups. No statistical difference in cardiac output between PH and NBP groups, as well as, in lactic acid levels between PH and NBP. NF group had significantly higher lactic acidosis and had significantly lower organ perfusion.ConclusionsHypotensive resuscitation causes less intra-abdominal bleeding than normotensive resuscitation and concurrently maintains equivalent organ perfusion. No fluid resuscitation reduces intra-abdominal bleeding but also significantly reduces organ perfusion.

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The Mouse in Shock

Schwacha

Chaudry

2004

Basic Science for the Cardiologist

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Resuscitation after Uncontrolled Venous Hemorrhage

Cited by 38 publications

References 23 publications

Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

Permissive hypotension does not reduce regional organ perfusion compared to normotensive resuscitation: animal study with fluorescent microspheres

The Mouse in Shock

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