Abstract 3: Detailed Description of All Deaths in Both the Shock and Traumatic Brain Injury Cohorts of the Resuscitation Outcomes Consortium Hypertonic Saline Trials

Abstract

Introduction: In trials conducted by the Resuscitation Outcomes Consortium (ROC) in patients with traumatic hypovolemic shock (shock) or traumatic brain injury (TBI), hypertonic saline failed to demonstrate improved survival. We sought to identify causes of mortality in this patient population to determine targets for future studies. Methods: Retrospective review of patients enrolled in a multicenter, randomized, clinical trial performed 2006-2009 by 114 EMS agencies in North America within ROC. Inclusion criteria were injured patients, age ≥ 15 years with hypovolemic shock (SBP ≤ 70 mm Hg or SBP 71-90 mm Hg with HR ≥ 108) or severe TBI [Glasgow Coma Score (GCS) ≤8]. Initial resuscitation fluid administered by out-of-hospital providers was 250 mL of either 7.5% saline with 6% dextran 70, 7.5% saline or 0.9% saline. Results: 2071 subjects were enrolled (821 shock, 1250 TBI). Survivors were younger than non-survivors [30(IQR 23) vs 42(34)] and had a higher GCS, though similar hemodynamics. Greater than 90% of deaths occurred despite ongoing resuscitative efforts. Forty six percent of the deaths in the TBI cohort were within 24 hours, compared with 81% in the shock cohort and 72% in the cohort with both shock and TBI. Median time to death was 29 hours in the TBI cohort, 2 hours in the shock cohort, and 4 hours in patients with both. Conclusion: Most deaths from trauma occur within the first 24 hrs from hypovolemic shock or TBI. Late deaths from sepsis and multiple organ failure are rare. Novel resuscitation strategies should focus on early deaths.