Resuscitation Of Trauma Patients Research Articles

Role Identity During the Resuscitation of Trauma Patients.

Full trauma team activations (TTAs) are initiated for patients meeting criteria that are indicative of life-threatening injuries. This influx of medical personnel causes crowding, as well as increased noise. Both adverse effects create an environment that is prone to medical errors, miscommunication, and physical limitations reaching the patient. A perception survey was issued to all members of the trauma-resuscitation team. The survey focused on the perception of organization, role identity, communication, crowding, and noise during the resuscitation. Following the conclusions of the survey, a role identity process was initiated. The roles of each team member were preprinted on neon stickers and kept at the door of the trauma bay. Team members were required to don a sticker to be in the resuscitation room. Seven months after the initiation of this process, the original survey was reissued. A total of 141 team members completed the preimplementation survey, and 96 completed the postimplementation survey. A significant difference was found in the perception of less noise (p = .009) and improved communication (p =.005) during the trauma resuscitation. No significant difference was determined regarding the perception of organization (p = .175) or improvement in knowing the roles of all the team members (p = .090). Having a mechanism to identify the members of the trauma team during a full TTA resuscitation has shown to limit overcrowding, improve communication, and decrease noise during trauma resuscitation. This mechanism ensures appropriate personnel are present during this phase of the critically injured patient.

Open-chest versus closed-chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study

BackgroundThe effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable. Although current guidelines state that the presence of signs of life (SOL) is an indication for OCCPR, scientific evidence corroborating this recommendation has been scarce. This study aimed to compare the effectiveness of OCCPR to closed-chest cardiopulmonary resuscitation (CCCPR) in severe trauma patients with SOL upon arrival at the emergency department (ED).MethodsA retrospective cohort study analyzing data from the Trauma Quality Improvement Program (TQIP) database, a nationwide trauma registry in the USA, between 2010 and 2016 was conducted. Severe trauma patients who had SOL upon arrival at the hospital and received cardiopulmonary resuscitation within the first 6 h of ED admission were identified. Survival to hospital discharge was evaluated using logistic regression analysis, instrumental variable analysis, and propensity score matching analysis adjusting for potential confounders.ResultsA total of 2682 patients (OCCPR 1032; CCCPR 1650) were evaluated; of those 157 patients (15.2%) in the OCCPR group and 193 patients (11.7%) in the CCCPR group survived. OCCPR was significantly associated with higher survival to hospital discharge in both the logistic regression analysis (adjusted odds ratio [95% confidence interval] = 1.99 [1.42–2.79], p < 0.001) and the instrumental variable analysis (adjusted odds ratio [95% confidence interval] = 1.16 [1.02–1.31], p = 0.021). In the propensity score matching analysis, 531 matched pairs were generated, and the OCCPR group still showed significantly higher survival at hospital discharge (89 patients [16.8%] in the OCCPR group vs 58 patients [10.9%] in the CCCPR group; odds ratio [95% confidence interval] = 1.66 [1.13–2.42], p = 0.009).ConclusionsCompared to CCCPR, OCCPR was associated with significantly higher survival at hospital discharge in severe trauma patients with SOL upon ED arrival. Further studies to confirm these results and to assess long-term neurologic outcomes are needed.

An international survey on the use of low titer group O whole blood for the resuscitation of civilian trauma patients in 2020.

An international survey on the use of low titer group O whole blood for the resuscitation of civilian trauma patients in 2020.

Current state of whole blood transfusion for civilian trauma resuscitation.

Whole blood (WB) is rapidly emerging as the treatment modality of choice for the initial resuscitation of civilian trauma patients across the United States. The reemergence of WB has been rapid and driven in part by recognition of the importance of early plasma transfusion in the resuscitation process. The study was designed as a critical analysis of the available literature on WB transfusion in civilian trauma patients. Studies were included if they reported on transfusion of cold-stored WB used in a civilian setting and measured safety, feasibility, or a direct clinical outcome. Examination of the available literature supports the feasibility and safety of WB used in treatment of civilian trauma patients. The evidence regarding clinical outcomes, particularly with direct comparison to equivalent doses of component therapy, is more limited. The literature is predominantly descriptive and retrospective in nature and limited by the heterogeneity of clinical WB protocols being used. Based on this limited data set, there are limited conclusions that can be used to definitely support or refute the clinical superiority of WB to component therapy. Current literature supports the safety and feasibility of WB, but prospective randomized trials comparing WB to component therapy are needed to provide the definitive evidence on this topic.

Essential aspects during the resuscitation of intravascular volume in polytraumatized patients

Trauma is the leading cause of death in the first four decades of life, responsible for 3.5 million deaths a year and carrying a high economic and social impact. Hemorrhagic shock is the consequence of injuries in these patients. Despite extensive knowledge about its pathophysiology and many replacement drugs and therapies, resuscitation of the intravascular volume sometimes is insufficient and ineffective. Hemorrhagic shock, resulting in macro and microvascular changes that favor the development of anaerobic metabolism, is associated with multiple complications that can lead to the demise of the patient. The purpose of this article is to describe the essential aspects that should be taken into account during the resuscitation of the intravascular volume of multiple trauma patients. We conducted a search and review of the available literature on the resuscitation of trauma patients. Reference searches were conducted in the MEDLINE/PubMed, Cumed, SciELO, EBSCO, Hinari, Cochrane databases. We reviewed the historical evolution of volume replacement in the polytrauma patient, endothelial glycocalyx, changes in the Starling law paradigm, goal-guided resuscitation, the different fluids used during resuscitation, monitoring, and the concepts of damage control resuscitation and damage control surgery.

Resuscitative Endovascular Balloon occlusion of the aorta in Impending Traumatic arrest: Is It Effective?

Purpose: Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations. Methods: This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups. Results: We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%. Conclusions: Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.

Intraosseous access in the resuscitation of trauma patients: a literature review.

Intraosseous (IO) catheters continue to be recommended in trauma resuscitation. Their utility has recently been debated due to concerns regarding inadequate flow rates during blood transfusion, and the potential for haemolysis. The objective of this review was to examine the evidence for intraosseous catheters in trauma resuscitation, and to highlight areas for future research. A PubMed and Embase search for articles published from January 1990 to August 2018 using the terms ("intra-osseous access" or "intraosseous access" or "IO access") AND trauma was performed. Original articles describing the use of an IO catheter in the resuscitation of one or more trauma patients were eligible. Animal, cadaveric studies and those involving healthy volunteers were excluded. Nine studies, comprising of 1218 trauma patients and 1432 device insertions, were included. The insertion success rate was 95% and the incidence of complications 0.9%. Flow-rate data and evidence of haemolysis were poorly reported. Intraosseous catheters have high insertion success rates and a low incidence of complications in trauma patients. Existing evidence suggests that IO transfusion is not associated with haemolysis, however, further studies in humans are needed. There is a paucity of flow rate data for blood transfusion via IO catheters in this population, although much anecdotal evidence advocating their use exists.

Modern Management of Bleeding, Clotting, and Coagulopathy in Trauma Patients: What Is the Role of Viscoelastic Assays?

The purpose of this review is to briefly outline the current state of hemorrhage control and resuscitation in trauma patients with a specific focus on the role viscoelastic assays have in this complex management, to include indications for use across all phases of care in the injured patient. Viscoelastic assay use to guide blood-product resuscitation in bleeding trauma patients can reduce mortality by up to 50%. Viscoelastic assays also reduce total blood products transfused, reduce ICU length of stay, and reduce costs. There are a large number of observational and retrospective studies evaluating viscoelastic assay use in the initial trauma resuscitation, but only one randomized control trial. There is a paucity of data evaluating use of viscoelastic assays in the operating room, post-operatively, and during ICU management in trauma patients, rendering their use in these settings extrapolative/speculative based on theory and data from other surgical disciplines and settings. Both hypocoagulable and hypercoagulable states exist in trauma patients, and better indicate what therapy may be most appropriate. Further study is needed, particularly in the operating room and post-operative/ICU settings in trauma patients.

Impact of raising serum myoglobin on resuscitation of trauma patients with high injury severity score (ISS)

IntroductionRecent studies recommend limiting the amount of crystalloid perfused during resuscitation for trauma patients. Severely injured patients sustain extensive muscle damage with subsequent high serum myoglobin levels precipitating acute renal injury if not treated immediately. To timely identify patients at risk of acute renal injury, we proposed determining the strength of the correlation between the American College of Surgeons–defined injury severity score with serum and urine myoglobin level in the early hours of arrival to the emergency department to determine the patient at higher risk of raising serum myoglobin level and subsequent renal injury. MethodA retrospective analysis was conducted at a 400-bed community teaching hospital with a level 2 trauma section and annual admission of 750–800 patients using the data in the trauma registry (2010–2017). Patients with an injury severity score of 15 or above were selected, and Student t test and Pearson correlation 2-tailed analysis were used to identify the relationship with serum myoglobin. ResultThere were 306 patients total, with 200 men (70.3%) and 106 women (29.7%) and a mean age of 60.64 (SD = 23.6) (range 18–96) years. The mean injury severity score was 22.3 (SD = 8.5) (range 16–75). The median level of serum myoglobin in the first 24 hours of admission was 848.56 ng/mL (range 22–11,197). There was a strong and significant correlation between the 2 variables (r = 0.397, P < .0001). ConclusionThe appearance of urine myoglobin with serum level of 39 ng/mL suggests that with higher injury severity score, the potential for acute kidney injury is likely and should be addressed early in the patient management.

Aggressive Crystalloid Resuscitation Outcomes in Low-Severity Pediatric Trauma

BackgroundTrauma is the leading cause of death among children. Studies have found that insufficient intravenous (IV) fluid resuscitation contributes significantly to morbidity and mortality in pediatric trauma. While large-volume resuscitation represents a potential solution, overly aggressive fluid management may complicate hospitalizations and recovery. Through this study, we aim to evaluate the impact of aggressive fluid resuscitation on outcomes in pediatric trauma. Materials and methodsThis is a retrospective review utilizing our level I trauma center registry for pediatric patients aged <16 y admitted from 2014 to 2017. Patients transferred from our center within 24 h and those who arrived from outside hospitals were excluded. Patients who received blood product transfusions were excluded. Included patients were divided into two crystalloid groups: <60 mL/kg/24 h and ≥60 mL/kg/24 h. Outcome measures included ICU length-of-stay, length-of-hospitalization, complications, and mortality rate. ResultsStudy sample included 320 patients (<60 mL/kg/24 h = 219; ≥60 mL/kg/24 h = 101). The ≥60 mL/kg/24 h group was younger (9.95 versus 5.27, P = 0.0001). There were no significant differences in GCS on arrival, injury severity score, Abbreviated Injury Scale, Revised Trauma Scores, traumatic brain injury, and operative intervention between groups. Outcome measures showed there was no significant difference in 30-day readmission rate, complications, or mortality. Large-volume crystalloid resuscitation was associated with longer mean ICU length-of-stay (1.5 d versus 0.8 d, P = 0.004). ConclusionsIn this single-institution retrospective database analysis, large-volume crystalloid resuscitation (≥60 mL/kg) was associated with a significant increase in ICU length-of-stay without survival benefit. More research in the form of randomized trials will help determine the optimal rate for fluid resuscitation in pediatric trauma patients while weighing potential critical care complications.

Early coagulation support protocol: A valid approach in real-life management of major trauma patients. Results from two Italian centres

IntroductionEarly coagulation support (ECS) includes prompt infusion of tranexamic acid, fibrinogen concentrate, and packed red blood cells for initial resuscitation of major trauma patients. The aim of this study was to determine the effects, in terms of blood product consumption, length of stay, and in-hospital mortality, of the ECS protocol, compared to the massive transfusion protocol (MTP) in the treatment of major trauma patients. Patients and methodsA retrospective analysis was conducted using the registry data of two Italian trauma centres. Adult major trauma patients with, or at risk of, active bleeding who were managed according to the MTP during the years 2011–2012, or the ECS protocol during the years 2013–2014 and were considered at risk of multiple transfusions, were enrolled. The primary endpoint was to determine whether the ECS protocol reduces the use of blood products in the acute management of trauma patients. Secondary endpoints were the outcome measures of length of stay in ICU, length of stay in hospital, and mortality at 24-hours and 28-days after hospital admission. ResultsAmong the 518 major trauma patients admitted to the trauma centres during the study period, 235 patients (118 in the pre-ECS period and 117 in the ECS period) matched one of the inclusion criteria and were enrolled in the study. Compared with the pre-ECS period, the ECS period showed a reduction in the average consumption of packed red blood cells (−1.87 units, 95% confidence interval [CI], −2.40, −1.34), platelets (−1.28 units; 95% CI, −1.64, −0.91), and fresh frozen plasma (−1.69; 95% CI, −2.14, −1.25) in the first 24-hours. Furthermore, during the ECS period, we recorded a 10-day reduction in the hospital length of stay (−10 days, 95% CI, −11.6, −8.4) and a non-significant 28-day mortality increase. ConclusionsThe ECS protocol was effective in reducing blood product consumption compared to the MTP and confirmed the importance of early fibrinogen administration as a strategy of rapid coagulation. This novel approach may be adopted in real-life management of major trauma patients.

Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock

Current therapies for traumatic blood loss focus on hemorrhage control and blood volume replacement. Severe hemorrhagic shock, however, is associated with a state of arginine vasopressin (AVP) deficiency, and supplementation of this hormone may decrease the need for blood products in resuscitation. To determine whether low-dose supplementation of AVP in patients with trauma (hereinafter referred to as trauma patients) and with hemorrhagic shock decreases their need for transfused blood products during resuscitation. This randomized, double-blind placebo-controlled clinical trial included adult trauma patients (aged 18-65 years) who received at least 6 U of any blood product within 12 hours of injury at a single urban level 1 trauma center from May 1, 2013, through May 31, 2017. Exclusion criteria consisted of prehospital cardiopulmonary resuscitation, emergency department thoracotomy, corticosteroid use, chronic renal insufficiency, coronary artery disease, traumatic brain injury requiring any neurosurgical intervention, pregnancy, prisoner status, or AVP administration before enrollment. Data were analyzed from May 1, 2013, through May 31, 2017, using intention to treat and per protocol. After administration of an AVP bolus (4 U) or placebo, participants received AVP (≤0.04 U/min) or placebo for 48 hours to maintain a mean arterial blood pressure of at least 65 mm Hg. The primary outcome was total volume of blood product transfused. Secondary end points included total volume of crystalloid transfused, vasopressor requirements, secondary complications, and 30-day mortality. One hundred patients underwent randomization (49 to the AVP group and 51 to the placebo group). Patients were primarily young (median age, 27 years [interquartile range {IQR}, 22-25 years]) and male (n = 93) with penetrating trauma (n = 79). Cohort characteristics before randomization were well balanced. At 48 hours, patients who received AVP required significantly less blood products (median, 1.4 [IQR, 0.5-2.6] vs 2.9 [IQR, 1.1-4.8] L; P = .01) but did not differ in requirements for crystalloids (median, 9.9 [IQR, 7.9-13.0] vs 11.0 [8.9-15.0] L; P = .22) or vasopressors (median, 400 [IQR, 0-5900] vs 1400 [IQR, 200-7600] equivalent units; P = .22). Although the groups had similar rates of mortality (6 of 49 [12%] vs 6 of 51 [12%]; P = .94) and total complications (24 of 44 [55%] vs 30 of 47 [64%]; P = .37), the AVP group had less deep venous thrombosis (5 of 44 [11%] vs 16 of 47 [34%]; P = .02). Low-dose AVP during the resuscitation of trauma patients in hemorrhagic shock decreases blood product requirements. Additional research is necessary to determine whether including AVP improves morbidity or mortality. ClinicalTrials.gov identifier: NCT01611935.

The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX

BackgroundPrehospital management of the traumatically injured patient has evolved significantly since the organization of emergency medical services across the United States in the 1970s. Initially focusing on the utilization of crystalloid solutions to restore shed blood volume, robust military and civilian trauma experiences led to a modern day shift towards balanced blood component and ultimately whole blood use for immediate volume replacement. In addition, prehospital transfusion or remote damage control resuscitation (RDRC) has been widely adopted. This has led to point of injury resuscitation using blood products both in the United States and abroad.ObjectivesThis article will review the evolution of civilian and military prehospital resuscitation as well as the current practice of prehospital whole blood transfusion in the civilian trauma population in the United States. Additionally, we will provide an overview of our regional trauma system's use of whole blood with focus on the programme infrastructure, donor programme, product rotation schedule and logistical challenges. Finally, we provide three case report examples of the effective use of whole blood in our civilian emergency medical services (EMS) programs.

3-Factor Versus 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three.

Coagulopathy of trauma (COT) is common and highly lethal. Prothrombin complex concentrate (PCC) has been advocated for correction of COT. However, the difference in efficacy between three-factor PCC (3-PCC) versus four-factor PCC (4-PCC) remains unclear. The aim of our study was to compare efficacy of 3-PCC versus 4-PCC in COT. Five-year (2013-2017) review of coagulopathic trauma patients at our Level-I trauma center who received 3- or 4-PCC. Patients were divided into two groups (4-PCC and 3-PCC) and matched in 1:1 ratio using propensity-score-matching for demographics, injury parameters, admission vitals, and hematological parameters. Primary outcomes were time to correction of international normalized ratio (INR), blood products transfusion, thromboembolic complications, and mortality. Secondary outcomes were hospital-length of stay (LOS), intensive care unit (ICU)-LOS, cost of therapy, and total hospital cost. Six hundred fifty-seven patients met inclusion criteria of whom 250 patients (4-PCC:125; 3-PCC:125) were matched. The mean age was 50 ± 19.4 y, 64% were male, and median-injury severity score was 24[15-33]. 4-PCC was associated with accelerated correction of INR (365 vs. 428 min, P = 0.01), decrease in red blood cells (7 units vs. 10 units, P = 0.04) and FFP (6 units vs. 8 units, P = 0.03) transfused. There was no difference in platelet transfusion, thromboembolic complications, mortality, hospital, and ICU-LOS. 4-PCC was associated with higher cost of PCC therapy, and lower cost of transfusion. There was no difference regarding the total hospital cost between the two groups. Compared with 3-factor PCC, the use of 4-factor PCC is associated with a rapid reversal of INR and reduction in transfusion requirement without increasing the overall hospital cost or the risk of thromboembolic events. 4-PCC may be preferred as an adjunct for the resuscitation of coagulopathic trauma patients.

Contemporary Transfusion Science and Challenges.

Health care professionals must understand the impact of blood product transfusions and transfusion therapy procedures to ensure high-quality patient care, positive outcomes, and wise use of resources in blood management programs. Understanding transfusions of blood and blood products is also important because of the number of treatments performed, which affects individual patients and health care system resources. This article reviews research findings to acquaint health care professionals with the most successful protocols for blood, blood product, and coagulation factor transfusions. Damage control resuscitation in bleeding trauma patients, protocols for patients without trauma who are undergoing surgical procedures that place them at risk for excessive bleeding, and protocols for patients with sepsis are addressed. Emerging research continues to help guide mass transfusion treatments (restrictive vs liberal, balanced, and goal-directed treatment). Although available study results provide some guidance, questions remain. Additional research by health care professionals is needed.

Impact of Raising Serum Myoglobin on Resuscitation of Trauma Patients with High Injury Severity Score (ISS)

Recent studies recommend limiting the amount of crystalloid perfused during resuscitation for trauma patients. However, severely injured patients sustain extensive muscle damage with subsequent high serum myoglobin levels precipitating acute renal injury (ARI) if not treated immediately. To timely identify patients at risk of ARI, we proposed determining the strength of the correlation between the American College of Surgeons defined injury severity score (ISS) and the serum and urine myoglobin level in the early hours of arrival to the emergency room to determine the patient at higher risk of raising serum myoglobin level and subsequent renal injury. A retrospective analysis was conducted at a 400-bed community teaching hospital with a level 2 trauma section and annual admission of 750-800 patients utilizing the data in the trauma registry(2010-2017). Patients with an ISS score of 15 or above were selected and student t-test and Pearson correlation two tailed analysis was used to identify the relationship with serum myoglobin. There were 306 patients total, with 200 males (70.3%) and 106 females (29.7%) and a mean age of60.64 (SD=23.6) (range 18-96). The mean ISS was 22.3 (SD=8.5) (range16-75). The median level of serum myoglobin in the first 24 hours of admission was 848.56 ng/mL (range 22-11,197). There was a strong and significant correlation between the two variables (r=0.397, p<0.0001). The appearance of urine myoglobin with serum level of 39 ng/mL, suggest that with higher ISS acute kidney injury is likely, and should be addressed early in the patient management. We recommend that attention should be diverted toward urine alkalinization and diuretics using crystalloid following initial resuscitation.

Is prehospital administration of freeze-dried plasma effective for resuscitation of hypotensive adult trauma patients?

Blanchfield Army Community Hospital, Fort Campbell, KY Carl R. Darnall FMR, Fort Hood, TX The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U.S. Army Medical Department, the Army at large or the Department of Defense.

What's new for trauma haemorrhage management?

Uncontrolled haemorrhage is the leading cause of preventable death from injury and is a major contributor to the global burden of disease. The majority of deaths resulting from bleeding occur within the first 3 hours of hospital admission, and the window for meaningful intervention is therefore extremely small. Resuscitative efforts during active bleeding should focus on maintaining haemostatic function with blood product transfusion and early administration of tranexamic acid. Achieving control of haemorrhage is the overarching treatment priority and may require temporising measures before definitive surgical or radiological intervention. This review summarizes the contemporary approaches to resuscitation of bleeding trauma patients, options for achieving haemorrhage control, and current areas of active research including organ protective resuscitation and suspended animation.

Aggressive crystalloid adversely affects outcomes in a pediatric trauma population.

Crystalloid resuscitation for trauma patients is deleterious, and minimizing crystalloid use is advocated. The purpose of this study was to evaluate the adverse effects of high-volume resuscitation in pediatric blunt trauma patients. This study included a retrospective review of 291 patients with blunt trauma from January 2007 to Apr 2018 at the Children's Hospital, Chongqing Medical University. Patients were dichotomized into low and high groups depending on the average dose of crystalloid fluid administration with a cut-off point during the first 24 or 48h. Propensity score matching was used based on measurable baseline factors to minimize confounding. The associations between crystalloid administration and clinical outcomes were determined according to the corresponding methods. Patients who received larger doses of crystalloids were more likely than the low-volume group to be associated with severe anemia (p = 0.033, p = 0.042, respectively), RBC transfusion (p = 0.016, p = 0.009, respectively) and longer hospital length of stay (p = 0.008, p = 0.002, respectively). In terms of plasma transfusion and oral solid diet, there were marginally significant differences noted in the dichotomized groups at 24h (p = 0.074), with significant differences at 48h (p = 0.013). Significant unfavorable outcomes were noted following excessive crystalloid resuscitation within the first 48h among pediatric patients with blunt trauma. Our findings support the notion that excessive fluid resuscitation should be avoided.

An increase in heart rate variability can be an index for end point of resuscitation in trauma patients

PurposeThe measurement of heart rate variability (HRV) is a non-invasive method to analyze the balance of the autonomic nervous system. The aim of this study was to compare the changes of HRV and base deficit (BD) during the treatment of trauma patients. MethodsForty-three trauma patients with a low injury severity scores (ISS < 24) and negative base excess on admission were included in this study. Based on the BD changes, patients were divided into three groups: ‘end pointed’ group (n = 13), patients' BDs instantly cleared after primary hydration; ‘needs further resuscitation’ group (n = 21), patients' BDs did not reach the end point and thus required further hydration or packed red blood cells transfusion; and ‘hydration minimal change’ group (n = 9), patients' BDs lower than 2.5 mmol/L at the onset of admission and thereafter had minimal change (near normal range). The changes in HRV during fluid resuscitation were detected and compared to BD changes in their arterial blood gases. All data were analysed using the SPSS software Version 15.0. Repeated measures ANOVA was used to determine the changes in HRV, heart rate, blood pressure, and BD among groups. ResultsA significant reverse correlation was found between the BD ratio and the HRV ratio (r = −0.562; p = 0.01). The HRV of patients with aggravated BDs after fluid resuscitation was decreased. There was an increase in HRV at the time of BD clearance. A decrease in HRV after primary crystalloid hydration bore a significant connection with the need for an ICU (p = 0.021) and transfusion of packed red blood cells (p < 0.001). ConclusionIncrease in HRV may be a new non-invasive index for the end point of resuscitation in trauma patients.