Impact of the utilization of 500mL IV bags on crystalloid resuscitation volumes administered to trauma patients.

Abstract

Administering large volumes of crystalloids to trauma patients has been shown to exacerbate metabolic complications of hemorrhage including dilutional coagulopathy and worsening acidosis The aim of this study was to evaluate crystalloid administration volumes in trauma patients after replacing 1L IV containers with 500mL IV containers in the emergency department trauma resuscitation bay. This was a single-center, IRB-approved, retrospective cohort evaluation of adult trauma patients conducted at an 864-bed community tertiary referral center located in the southeastern United States. Patterns of crystalloid administration were examined before and after the trauma resuscitation bay began to exclusively stock 500mL IV containers. The primary outcome was mean total crystalloid volume infused from time of injury to hospital admission. Secondary outcomes included mean total crystalloid volume infused prior to administration of blood products, proportion of patients who received less than 2L total of crystalloids, time to initiation of blood products, and mortality in both the emergency department and in-hospital. Patient characteristics were largely similar between both groups including age, mechanism of injury, and Injury Severity Score. For the primary outcome, the mean total crystalloid volume infused from time of injury to hospital administration, patients in the 500mL IV fluid container group were administered 555mL less crystalloid when compared to the 1L IV fluid container group, 1048mL vs 1603mL (p<0.01; 95% CI 406mL - 704mL), respectively. After conversion to the 500mL IV container bags, there was a 27.5% increase in the proportion of patients receiving less than 2L of crystalloid, 90.5% vs 63.0% in the 500mL IV fluid container and 1L IV fluid container groups, respectively (p<0.01). Due to reduced mortality, expanding literature and guidelines clearly support minimizing IV crystalloid resuscitation. Institutions must now work to minimize use of IV crystalloids to hemorrhaging trauma patients and a simple solution of using smaller IV fluid bags was shown to improve adherence to this practice.