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Is the use of greater than 1 L of intravenous crystalloids associated with worse outcomes in trauma patients?

  • Tony Zitek
    Correspondence
    Corresponding author at: 91500, Overseas Hwy Tavernier, FL 33070, United States of America.
    Affiliations
    Department of Emergency Medicine, Herbert Wertheim College of Medicine, Florida International University, 11200, SW Eight St Miami, FL 33199, United States of America

    Department of Emergency Medicine, University Medical Center of Southern Nevada, 1800, W Charleston Blvd Las Vegas, NV 89102, United States of America
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  • Ramsey Ataya
    Affiliations
    Department of Emergency Medicine, Kendall Regional Medical Center, 11750, Bird Rd Miami, FL 33175, United States of America
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  • Lian Farino
    Affiliations
    Department of Emergency Medicine, University of Nevada Las Vegas School of Medicine, 2040, W Charleston Blvd, 3rd Floor, Las Vegas, NV 89102, United States of America
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  • Salman Mohammed
    Affiliations
    Department of Emergency Medicine, University Medical Center of Southern Nevada, 1800, W Charleston Blvd Las Vegas, NV 89102, United States of America
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  • Glenn Miller
    Affiliations
    Department of Surgery, Kendall Regional Medical Center, 11750, Bird Rd Miami, FL 33175, United States of America
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Published:December 10, 2020DOI:https://doi.org/10.1016/j.ajem.2020.12.013

      Abstract

      Objective

      Advanced Trauma Life Support guidelines recommend only 1 L of intravenous (IV) crystalloid before transitioning to blood products. We sought to determine if receiving >1 L of IV crystalloid during the initial resuscitation is associated with worse outcomes. We also sought to determine if receiving no crystalloids is associated with better outcomes.

      Methods

      We performed a single center retrospective study using trauma registry data, which was supplemented by manual chart review. We only included patients who had an initial heart rate ≥ 100 beats/min or a systolic blood pressure ≤ 90 mmHg. For each patient, we determined the total amount of IV crystalloid administered in the first 3 h after arrival to the hospital plus prehospital crystalloid. We performed multivariate regression analyses to determine if there is an association between the administration of >1 L of crystalloids or no crystalloids with in-hospital mortality, hospital length of stay (LOS), or packed red blood cells (PRBCs) transfused.

      Results

      Between January 1, 2018 and September 30, 2019, there were 878 who met criteria for enrollment. Among those, 55.0% received ≤1 L of IV crystalloids, and 45.0% received >1 L. Multivariate analyses showed no significant association between receiving >1 L and mortality (p = 0.61) or PRBCs transfused (p = 0.29), but patients who received >1 L had longer hospital LOS (p = 0.04). We found no association between receiving no crystalloids and mortality, PRBCs transfused, or LOS.

      Conclusion

      On a multivariate analysis of trauma patients, we did not find an association between the administration of >1 L of IV crystalloid and in-hospital mortality or the volume of PRBCs transfused. However, receiving >1 L of crystalloids was associated with a longer hospital LOS. We found no benefit to completely withholding crystalloids.

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