TY - JOUR
T1 - Prehospital hypertonic fluid resuscitation for trauma patients
T2 - A systematic review and meta-analysis
AU - De Crescenzo, Claire
AU - Gorouhi, Farzam
AU - Salcedo, Edgardo S.
AU - Galante, Joseph M.
PY - 2017
Y1 - 2017
N2 - Background: Prehospital assessment of a patient's circulation status and appropriate resuscitation with intravenous fluids plays a critical role in patients with obvious hemorrhage or systolic blood pressure below 90 mm Hg. Objectives: We assessed the efficacy and safety of prehospital administration of crystalloids or colloids to improve the survival rate of trauma patients with acceptable safety profile. Data Sources: We searched SCOPUS, Embase, TRIP database, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Pub Med as per search protocol from January 1, 1900 to February 12, 2015. Study Eligibility Criteria: All randomized controlled trials were considered. Participants and Interventions: All patients had penetrating or blunt trauma, excluding traumatic brain or thermal injuries. At least one of the comparators should be a crystalloid or colloid. Studyappraisal and Synthesis Methods: Detailed search strategy was developed and utilized. Duplicates were removed from the search results. We, the co-first authors (C.d.C. and F.G.), independently reviewed the article titles and abstracts to assess eligibility. Eligible articles were downloaded for full text review to determine inclusion in the reviewand analysis. We (C.d.C. and F.G.) performed a methodological quality assessment of each included article. The primary outcome was mortality. The secondary outcomes included adverse events, infections, multiple organ dysfunction score, and length of stay at the hospital. Heterogeneity was measured by I2 value. An I2 value greater than 50% was considered to be substantial heterogeneity. Fixed effect analysis and random effect analysis were performed when needed. Results: A total of nine trials (3,490 patients) were included in the systematic review, and six trials were included in meta-analyses. There were no significant differences between hypertonic saline with dextran and lactated Ringer's solution in 1 day using two studies (2.91; 95% CI, 0.58-14.54; p = 0.19) and 28- to 30-day survival rates using another two studies (1.47; 95% CI, 0.30-7.18; p = 0.63). Adding dextran to hypertonic saline did not increase the survival rate (0.94; 95%CI, 0.65-1.34; p = 0.71). Overall, complications were comparable between all groups. Limitations: The quality of some of the included studies is not optimal. Conclusions and Implications of Key Findings: There is no beneficial effect of hypertonic saline with or without dextran in general traumatic patients. Further trials to evaluate its benefit in patients with penetrating trauma requiring surgery arewarranted.
AB - Background: Prehospital assessment of a patient's circulation status and appropriate resuscitation with intravenous fluids plays a critical role in patients with obvious hemorrhage or systolic blood pressure below 90 mm Hg. Objectives: We assessed the efficacy and safety of prehospital administration of crystalloids or colloids to improve the survival rate of trauma patients with acceptable safety profile. Data Sources: We searched SCOPUS, Embase, TRIP database, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Pub Med as per search protocol from January 1, 1900 to February 12, 2015. Study Eligibility Criteria: All randomized controlled trials were considered. Participants and Interventions: All patients had penetrating or blunt trauma, excluding traumatic brain or thermal injuries. At least one of the comparators should be a crystalloid or colloid. Studyappraisal and Synthesis Methods: Detailed search strategy was developed and utilized. Duplicates were removed from the search results. We, the co-first authors (C.d.C. and F.G.), independently reviewed the article titles and abstracts to assess eligibility. Eligible articles were downloaded for full text review to determine inclusion in the reviewand analysis. We (C.d.C. and F.G.) performed a methodological quality assessment of each included article. The primary outcome was mortality. The secondary outcomes included adverse events, infections, multiple organ dysfunction score, and length of stay at the hospital. Heterogeneity was measured by I2 value. An I2 value greater than 50% was considered to be substantial heterogeneity. Fixed effect analysis and random effect analysis were performed when needed. Results: A total of nine trials (3,490 patients) were included in the systematic review, and six trials were included in meta-analyses. There were no significant differences between hypertonic saline with dextran and lactated Ringer's solution in 1 day using two studies (2.91; 95% CI, 0.58-14.54; p = 0.19) and 28- to 30-day survival rates using another two studies (1.47; 95% CI, 0.30-7.18; p = 0.63). Adding dextran to hypertonic saline did not increase the survival rate (0.94; 95%CI, 0.65-1.34; p = 0.71). Overall, complications were comparable between all groups. Limitations: The quality of some of the included studies is not optimal. Conclusions and Implications of Key Findings: There is no beneficial effect of hypertonic saline with or without dextran in general traumatic patients. Further trials to evaluate its benefit in patients with penetrating trauma requiring surgery arewarranted.
KW - Dextran
KW - Hypertonic saline
KW - Lactated Ringer's solution
KW - Prehospital fluid resuscitation
KW - Systematic review
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U2 - 10.1097/TA.0000000000001409
DO - 10.1097/TA.0000000000001409
M3 - Article
C2 - 28257392
AN - SCOPUS:85014209036
VL - 82
SP - 956
EP - 962
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 5
ER -