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.
Keywords
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Article Info
Publication History
Published online: December 10, 2020
Accepted:
December 5,
2020
Received in revised form:
December 5,
2020
Received:
November 11,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
