Enhanced Prehospital Volume Therapy Does Not Lead to Improved Outcomes in Severely Injured Patients with Severe Traumatic Brain Injury

Overview

Journal BMC Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2019 Jan 25

PMID 30674281

Citations 7

Authors

Bjoern Hussmann

Carsten Schoeneberg

Pascal Jungbluth

Matthias Heuer

Rolf Lefering

Teresa Maek

Frank Hildebrand

Sven Lendemans

Hans-Christoph Pape

Affiliations

Soon will be listed here.

Abstract

Background: Whether enhanced prehospital volume therapy leads to outcome improvements in severely injured patients with severe traumatic brain injury (TBI) remains controversial. The aim of this study was to investigate the influence of prehospital volume therapy on the clinical course of severely injured patients with severe TBI.

Methods: Data for 122,672 patients from TraumaRegister DGU (TR-DGU) was analyzed. Inclusion criteria were defined as follows: Injury Severety Score (ISS) ≥ 16, primary admission, age ≥ 16 years, Abbreviated Injury Scale (AIS) head ≥3, administration of at least one unit of packed red blood cells (pRBCs), and available volume and blood pressure data. Stratification based on the following matched-pair criteria was performed: group 1: prehospital volumes of 0-1000 ml; group 2: prehospital volumes of ≥1501 ml; AIS head (3, 4, 5 + 6 and higher than for other body regions); age (16-54, 55-69, ≥ 70 years); gender; prehospital intubation (yes/no); emergency treatment time +/- 30 min.; rescue resources (rescue helicopter, emergency ambulance); blood pressure (20-60, 61-90, ≥ 91 mmHg); year of accident (2002-2005, 2006-2009, 2010-2012); AIS thorax, abdomen, and extremities plus pelvis.

Results: A total of 169 patients per group fulfilled the inclusion criteria. Increasing volume administration was associated with reduced coagulation capability and reduced hemoglobin (Hb) levels (prothrombin ratio: group 1: 68%, group 2: 63.7%; p ≤ 0.04; Hb: group 1: 11.2 mg/dl, group 2: 10.2 mg/dl; p ≤ 0.001). It was not possible to show a significant reduction in the mortality rate with increasing volumes (group 1: 45.6, group 2: 45.6; p = 1).

Conclusions: The data presented in this study demonstrates that prehospital volume administration of more than 1500 ml does not improve severely injured patients with severe traumatic brain injury (TBI).

Citing Articles

Reality of treatment for severely injured patients: are there age-specific differences?.

Maek T, Fochtmann U, Jungbluth P, Pass B, Lefering R, Schoeneberg C BMC Emerg Med. 2024; 24(1):14.

PMID: 38267869 PMC: 10807120. DOI: 10.1186/s12873-024-00935-w.

Is prehospital intubation of severely injured children in accordance with guidelines?.

Maek T, Fochtmann U, von Loewenich A, Jungbluth P, Zimmermann W, Lefering R BMC Emerg Med. 2022; 22(1):194.

PMID: 36474145 PMC: 9724279. DOI: 10.1186/s12873-022-00750-1.

Association between vasopressor use and mortality in patients with severe traumatic brain injury: a nationwide retrospective cohort study in Japan.

Hosomi S, Sobue T, Kitamura T, Hirayama A, Ogura H, Shimazu T Acute Med Surg. 2021; 8(1):e695.

PMID: 34567578 PMC: 8448585. DOI: 10.1002/ams2.695.

A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes.

Bedard A, Mata L, Dymond C, Moreira F, Dixon J, Schauer S Int J Emerg Med. 2020; 13(1):64.

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Multifaceted Benefit of Whole Blood Versus Lactated Ringer's Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice.

Zusman B, Kochanek P, Bailey Z, Leung L, Vagni V, Okonkwo D Neurocrit Care. 2020; 34(3):781-794.

PMID: 32886294 PMC: 8054986. DOI: 10.1007/s12028-020-01084-1.

References

Haut E, Kalish B, Cotton B, Efron D, Haider A, Stevens K . Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a National Trauma Data Bank analysis. Ann Surg. 2010; 253(2):371-7. DOI: 10.1097/SLA.0b013e318207c24f. View

Albreiki M, Voegeli D . Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: a systematic review. Eur J Trauma Emerg Surg. 2017; 44(2):191-202. PMC: 5884894. DOI: 10.1007/s00068-017-0862-y. View

Sulheim S, Holme I, Ekeland A, Bahr R . Helmet use and risk of head injuries in alpine skiers and snowboarders. JAMA. 2006; 295(8):919-24. DOI: 10.1001/jama.295.8.919. View

Levy M, Fink M, Marshall J, Abraham E, Angus D, Cook D . 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003; 31(4):1250-6. DOI: 10.1097/01.CCM.0000050454.01978.3B. View

Gruen R, Jurkovich G, McIntyre L, Foy H, Maier R . Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg. 2006; 244(3):371-80. PMC: 1856538. DOI: 10.1097/01.sla.0000234655.83517.56. View

Hussmann B, Taeger G, Lefering R, Waydhas C, Nast-Kolb D, Ruchholtz S . [Lethality and outcome in multiple injured patients after severe abdominal and pelvic trauma. Influence of preclinical volume replacement - an analysis of 604 patients from the trauma registry of the DGU]. Unfallchirurg. 2010; 114(8):705-12. DOI: 10.1007/s00113-010-1842-4. View

Soudry E, Stein M . Prehospital management of uncontrolled bleeding in trauma patients: nearing the light at the end of the tunnel. Isr Med Assoc J. 2004; 6(8):485-9. View

Hartings J, Vidgeon S, Strong A, Zacko C, Vagal A, Andaluz N . Surgical management of traumatic brain injury: a comparative-effectiveness study of 2 centers. J Neurosurg. 2013; 120(2):434-46. DOI: 10.3171/2013.9.JNS13581. View

Tan P, Cincotta M, Clavisi O, Bragge P, Wasiak J, Pattuwage L . Review article: Prehospital fluid management in traumatic brain injury. Emerg Med Australas. 2011; 23(6):665-76. DOI: 10.1111/j.1742-6723.2011.01455.x. View

10.

Lefering R . Development and validation of the revised injury severity classification score for severely injured patients. Eur J Trauma Emerg Surg. 2016; 35(5):437-47. DOI: 10.1007/s00068-009-9122-0. View

11.

Soreide K, Kruger A, Vardal A, Lycke Ellingsen C, Soreide E, Lossius H . Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace, older face. World J Surg. 2007; 31(11):2092-103. DOI: 10.1007/s00268-007-9226-9. View

12.

Dula D, Wood G, Rejmer A, Starr M, Leicht M . Use of prehospital fluids in hypotensive blunt trauma patients. Prehosp Emerg Care. 2002; 6(4):417-20. DOI: 10.1080/10903120290938058. View

13.

Trunkey D . Prehospital fluid resuscitation of the trauma patient. An analysis and review. Emerg Med Serv. 2001; 30(5):93-5, 96, 98 passim. View

14.

HuBmann B, Lefering R, Taeger G, Waydhas C, Ruchholtz S . Influence of prehospital fluid resuscitation on patients with multiple injuries in hemorrhagic shock in patients from the DGU trauma registry. J Emerg Trauma Shock. 2011; 4(4):465-71. PMC: 3214502. DOI: 10.4103/0974-2700.86630. View

15.

Lendemans S, Kreuzfelder E, Waydhas C, Nast-Kolb D, Flohe S . [Clinical course and prognostic significance of immunological and functional parameters after severe trauma]. Unfallchirurg. 2004; 107(3):203-10. DOI: 10.1007/s00113-004-0729-7. View

16.

Sauaia A, Moore F, Moore E, Moser K, Brennan R, Read R . Epidemiology of trauma deaths: a reassessment. J Trauma. 1995; 38(2):185-93. DOI: 10.1097/00005373-199502000-00006. View

17.

Talving P, Palstedt J, Riddez L . Prehospital management and fluid resuscitation in hypotensive trauma patients admitted to Karolinska University Hospital in Stockholm. Prehosp Disaster Med. 2005; 20(4):228-34. DOI: 10.1017/s1049023x00002582. View

18.

Curry N, Davis P . What's new in resuscitation strategies for the patient with multiple trauma?. Injury. 2012; 43(7):1021-8. DOI: 10.1016/j.injury.2012.03.014. View

19.

Dutton R, Mackenzie C, Scalea T . Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma. 2002; 52(6):1141-6. DOI: 10.1097/00005373-200206000-00020. View

20.

Geeraedts Jr L, Pothof L, Caldwell E, de Lange-de Klerk E, DAmours S . Prehospital fluid resuscitation in hypotensive trauma patients: do we need a tailored approach?. Injury. 2014; 46(1):4-9. DOI: 10.1016/j.injury.2014.08.001. View