Early Crystalloid Resuscitation in Trauma: How Much Is Too Much?

Early Crystalloid Resuscitation in Trauma: How Much Is Too Much?

Authors: Sharon Goldman, Irina Radomislensky, Adi Givon, et al.
Journal: American Journal of Emergency Medicine, 2024

Conclusions

Administering ≥2 liters of crystalloids during early resuscitation is independently associated with increased mortality in hemodynamically unstable trauma patients. These findings support the need for goal-directed and judicious crystalloid use, aligning with damage control resuscitation principles.

Methods

• Design: Retrospective cohort study.
• Data Source: Israel National Trauma Registry (January 2013–December 2022).
• Population:
• Patients ≥16 years transported by emergency medical services (EMS).
• Systolic blood pressure <90 mmHg and/or shock index >1 in the field or ED.
• Excluded: Transfers, prehospital blood product administration, burns.
• Primary Outcome: All-cause in-hospital mortality.
• Analysis: Multivariable logistic regression adjusting for age, gender, injury severity (ISS), and hemodynamic parameters.

Results

• Cohort Characteristics (n=10,707):
• Median age: 39 years (IQR 25–65).
• 63.5% male, 81.4% blunt trauma (primarily motor vehicle collisions).
• Trends in Crystalloid Use:
• Reduced use over time in prehospital and ED settings.
• Crystalloid Volume and Mortality:
• Volumes ≥2 liters were independently associated with increased mortality:
• 2,000–2,499 mL: Adjusted OR (aOR) 1.47 (95% CI 1.09–1.96, p=0.01).
• ≥2,500 mL: aOR 1.49 (95% CI 1.08–2.04, p=0.01).
• Other factors associated with higher mortality:
• Older age, male gender, ISS >15, and lower systolic BP.