Fluid Resuscitation in the Prehospital Setting
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Abstract
Urban Emergency Medical Services benefit from an increased number of higher-level personnel (Advanced Emergency Medical Technicians and Paramedics) responding to all calls that are trained to obtain intravenous access. Current Advanced Trauma Life Support guidelines require all trauma patients to receive intravenous access, and as such it is essential for EMS clinicians to be conversant with situations which may require fluid resuscitation. These situations are especially common in rural or austere environments as long transport times require EMS clinicians to maintain adequate hemodynamics until arrival at a trauma center for definitive care. Historically, crystalloid solutions have been the mainstay of fluid resuscitation with Normal Saline or Lactated Ringer’s solution being preferred. Despite the recent shift in best practices from aggressive fluid resuscitation to delayed or significantly scaled back fluid resuscitation in most settings of trauma, it is essential for EMS clinicians to understand when fluid resuscitation is indicated, or, more importantly, contraindicated. EMS clinicians must be comfortable with the various fluids available to them in the field. This review provides an overview of the most common crystalloid fluids and blood component therapies which may be used for resuscitation in the prehospital setting.
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References
45% SODIUM CHLORIDE IRRIGATION, USP 0.9% SODIUM CHLORIDE IRRIGATION, USP. (n.d.). Retrieved April 12, 2024, from https://labeling.pfizer.com/ShowLabeling.aspx?id=4420
% and 5% Sodium ChlorideInjections USP, (Hypertonic). (2024). https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f2475fa3-ab1d-4b81-8127-b58cd0790a54&type=display
Advanced Burn Life Support Course Manual. (2023). American Burn Association. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://ameriburn.org/wp-content/uploads/2019/08/2018-abls-providermanual.pdf
Alam, H. B., Stanton, K., Koustova, E., Burris, D., Rich, N., & Rhee, P. (2004). Effect of different resuscitation strategies on neutrophil activation in a swine model of hemorrhagic shock. Resuscitation, 60(1), 91–99. https://doi.org/10.1016/j.resuscitation.2003.08.006
Alvis-Miranda, H. R., Castellar-Leones, S. M., & Moscote-Salazar, L. R. (2014). Intravenous Fluid Therapy in Traumatic Brain Injury and Decompressive Craniectomy. Bulletin of Emergency & Trauma, 2(1), 3–14.
Alvis-Miranda, H. R., Rubiano, A. M., Puyana, J. C., Alcala-Cerra, G., & Moscote-Salazar, L. R. (2014). Fluid therapy in neurotrauma: Basic and clinical concepts. Reviews in Health Care, 5(1), 7–22. https://doi.org/10.7175/rhc.v5i1.636
Barlow, A., Barlow, B., Tang, N., Shah, B. M., & King, A. E. (2020). Intravenous Fluid Management in Critically Ill Adults: A Review. Critical Care Nurse, 40(6), e17–e27. https://doi.org/10.4037/ccn2020337
Beran, A., Altorok, N., Srour, O., Malhas, S.-E., Khokher, W., Mhanna, M., Ayesh, H., Aladamat, N., Abuhelwa, Z., Srour, K., Mahmood, A., Altorok, N., Taleb, M., & Assaly, R. (2022). Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 11(7), Article 7. https://doi.org/10.3390/jcm11071971
Bickell, W. H., Wall, M. J., Pepe, P. E., Martin, R. R., Ginger, V. F., Allen, M. K., & Mattox, K. L. (1994). Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. The New England Journal of Medicine, 331(17), 1105–1109. https://doi.org/10.1056/NEJM199410273311701
Blumberg, N., Cholette, J. M., Pietropaoli, A. P., Phipps, R., Spinelli, S. L., Eaton, M. P., Noronha, S. A., Seghatchian, J., Heal, J. M., & Refaai, M. A. (2018). 0.9% NaCl (Normal Saline)—Perhaps not so normal after all? Transfusion and Apheresis Science: Official Journal of the World Apheresis Association: Official Journal of the European Society for Haemapheresis, 57(1), 127–131. https://doi.org/10.1016/j.transci.2018.02.021
Canac, N., Jalaleddini, K., Thorpe, S. G., Thibeault, C. M., & Hamilton, R. B. (2020). Review: Pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring. Fluids and Barriers of the CNS, 17(1), 40. https://doi.org/10.1186/s12987-020-00201-8
Casey, J. D., Brown, R. M., & Semler, M. W. (2018). Resuscitation Fluids. Current Opinion in Critical Care, 24(6), 512–518. https://doi.org/10.1097/MCC.0000000000000551
Chambers, J. A., Seastedt, K., Krell, R., Caterson, E., Levy, M., & Turner, N. (2019). “Stop the Bleed”: A U.S. Military Installation’s Model for Implementation of a Rapid Hemorrhage Control Program. Military Medicine, 184(3–4), 67–71. https://doi.org/10.1093/milmed/usy185
Cherkas, D. (2011). Traumatic hemorrhagic shock: Advances in fluid management. Emergency Medicine Practice, 13(11), 1–19; quiz 19–20.
Cotton, B. A., Jerome, R., Collier, B. R., Khetarpal, S., Holevar, M., Tucker, B., Kurek, S., Mowery, N. T., Shah, K., Bromberg, W., Gunter, O. L., Riordan, W. P. J., & Resuscitation, E. P. P. W. for P. F. (2009). Guidelines for Prehospital Fluid Resuscitation in the Injured Patient. Journal of Trauma and Acute Care Surgery, 67(2), 389. https://doi.org/10.1097/TA.0b013e3181a8b26f
Cull, D. L., Lally, K. P., & Murphy, K. D. (1991). Compatibility of packed erythrocytes and Ringer’s lactate solution. Surgery, Gynecology & Obstetrics, 173(1), 9–12.
Curran, J. D., Major, P., Tang, K., Bagshaw, S. M., Dionne, J. C., Menon, K., & Rochwerg, B. (2021). Comparison of Balanced Crystalloid Solutions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Critical Care Explorations, 3(5), e0398. https://doi.org/10.1097/CCE.0000000000000398
DEXTROSE- dextrose monohydrate injection, solution. (n.d.). Retrieved April 12, 2024, from https://labeling.pfizer.com/ShowLabeling.aspx?id=4616
Dimitriou, N. (2021). Basics of Trauma Management: Crush Injuries. In E. Pikoulis & J. Doucet (Eds.), Emergency Medicine, Trauma and Disaster Management. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-34116-9_22
Dong, W.-H., Yan, W.-Q., Song, X., Zhou, W.-Q., & Chen, Z. (2022). Fluid resuscitation with balanced crystalloids versus normal saline in critically ill patients: A systematic review and meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1), 28. https://doi.org/10.1186/s13049-022-01015-3
Ernstmeyer, & Christman. (2021, July 27). Intravenous Solutions. Medicine LibreTexts. https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/15%3A_Fluids_and_Electrolytes/15.03%3A_Intravenous_Solutions
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine, 49(11), e1063. https://doi.org/10.1097/CCM.0000000000005337
Fink, M. E. (2012). Osmotherapy for intracranial hypertension: Mannitol versus hypertonic saline. Continuum (Minneapolis, Minn.), 18(3), 640–654. https://doi.org/10.1212/01.CON.0000415432.84147.1e
Gump, F. E., Butler, H., & Kinney, J. M. (1968). Oxygen transport and consumption during acute hemodilution. Annals of Surgery, 168(1), 54–60.
Guyette, F. X., Zenati, M., Triulzi, D. J., Yazer, M. H., Skroczky, H., Early, B. J., Adams, P. W., Brown, J. B., Alarcon, L., Neal, M. D., Forsythe, R. M., Zuckerbraun, B. S., Peitzman, A. B., Billiar, T. R., & Sperry, J. L. (2022). PREHOSPTIAL LOW TITER GROUP O WHOLE BLOOD IS FEASIBLE AND SAFE: RESULTS OF A PROSPECTIVE RANDOMIZED PILOT TRIAL. The Journal of Trauma and Acute Care Surgery, 92(5), 839–847. https://doi.org/10.1097/TA.0000000000003551
Hanna, K., Bible, L., Chehab, M., Asmar, S., Douglas, M., Ditillo, M., Castanon, L., Tang, A., & Joseph, B. (2020). Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma. The Journal of Trauma and Acute Care Surgery, 89(2), 329–335. https://doi.org/10.1097/TA.0000000000002753
Harada, M. Y., Ko, A., Barmparas, G., Smith, E. J. T., Patel, B. K., Dhillon, N. K., Thomsen, G. M., & Ley, E. J. (2017). 10-Year trend in crystalloid resuscitation: Reduced volume and lower mortality. International Journal of Surgery, 38, 78–82. https://doi.org/10.1016/j.ijsu.2016.12.073
Hébert, S., Kohtakangas, E., Campbell, A., & Ohle, R. (2023). The efficacy of prehospital IV fluid management in severely injured adult trauma patients: A systematic review and meta-analysis. Canadian Journal of Emergency Medicine, 25(3), 200–208. https://doi.org/10.1007/s43678-023-00447-9
Henry, S. (2018). ATLS Advanced Trauma Life Support 10th Edition Student Course Manual. ACS American College of Surgeons.
Holcomb, J. B., Bank, E. A., Leppeke, S. N., Mendelsohn Stone, L., Krohmer, J., Schaefer, R., Homer, M. J., Flanagan, C., & Skillman, B. (2023, August 9). Prehospital Blood Transfusion Initiative Coalition. Presented to the National EMS Advisory Council.
Holcomb, J. B., del Junco, D. J., Fox, E. E., Wade, C. E., Cohen, M. J., Schreiber, M. A., Alarcon, L. H., Bai, Y., Brasel, K. J., Bulger, E. M., Cotton, B. A., Matijevic, N., Muskat, P., Myers, J. G., Phelan, H. A., White, C. E., Zhang, J., Rahbar, M. H., & PROMMTT Study Group. (2013). The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: Comparative effectiveness of a time-varying treatment with competing risks. JAMA Surgery, 148(2), 127–136. https://doi.org/10.1001/2013.jamasurg.387
Holcomb, J. B., Tilley, B. C., Baraniuk, S., Fox, E. E., Wade, C. E., Podbielski, J. M., del Junco, D. J., Brasel, K. J., Bulger, E. M., Callcut, R. A., Cohen, M. J., Cotton, B. A., Fabian, T. C., Inaba, K., Kerby, J. D., Muskat, P., O’Keeffe, T., Rizoli, S., Robinson, B. R. H., … PROPPR Study Group. (2015). Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA, 313(5), 471–482. https://doi.org/10.1001/jama.2015.12
Injuries and Violence Are Leading Causes of Death | Injury Center | CDC. (2023, August 2). https://www.cdc.gov/injury/wisqars/animated-leading-causes.html
Iqbal, U., Anwar, H., & Scribani, M. (2018). Ringer’s lactate versus normal saline in acute pancreatitis: A systematic review and meta-analysis. Journal of Digestive Diseases, 19(6), 335–341. https://doi.org/10.1111/1751-2980.12606
Janagama, S. R., Newberry, J. A., Kohn, M. A., Rao, G. V. R., Strehlow, M. C., & Mahadevan, S. V. (2022). Is AVPU comparable to GCS in critical prehospital decisions? - A cross-sectional study. The American Journal of Emergency Medicine, 59, 106–110. https://doi.org/10.1016/j.ajem.2022.06.042
Jarczak, D., Kluge, S., & Nierhaus, A. (2021). Sepsis—Pathophysiology and Therapeutic Concepts. Frontiers in Medicine, 8, 628302. https://doi.org/10.3389/fmed.2021.628302
Jaskille, A., Alam, H. B., Rhee, P., Hanes, W., Kirkpatrick, J. R., & Koustova, E. (2004). D-lactate increases pulmonary apoptosis by restricting phosphorylation of bad and eNOS in a rat model of hemorrhagic shock. The Journal of Trauma, 57(2), 262–269; discussion 269-270. https://doi.org/10.1097/01.ta.0000133841.95455.73
Jones, A. R., Miller, J. L., Jansen, J. O., & Wang, H. E. (2021). Whole Blood for Resuscitation of Traumatic Hemorrhagic Shock in Adults. Advanced Emergency Nursing Journal, 43(4), 344–354. https://doi.org/10.1097/TME.0000000000000376
Jones, D. G., Nantais, J., Rezende-Neto, J. B., Yazdani, S., Vegas, P., & Rizoli, S. (2018). Crystalloid resuscitation in trauma patients: Deleterious effect of 5L or more in the first 24h. BMC Surgery, 18, 93. https://doi.org/10.1186/s12893-018-0427-y
Jorgenson, M. (2017). Administration of Blood Components. In M. Fung, A. Eder, S. Spitalnik, & C. Westhoff (Eds.), Technical Manual (19th ed.). Association for the Advancement of Blood and Biotherapies.
Kaur, P., Basu, S., Kaur, G., & Kaur, R. (2011). Transfusion protocol in trauma. Journal of Emergencies, Trauma, and Shock, 4(1), 103–108. https://doi.org/10.4103/0974-2700.76844
Knight, C. D., Bebarta, V., Meledeo, M. A., Ross, E., Wu, X., Bynum, J., Schauer, S., Getz, T., & April, M. (2023). A narrative review of prehospital hemorrhagic shock treatment with non-blood product medications. Transfusion, 63 Suppl 3, S256–S262. https://doi.org/10.1111/trf.17324
Kudo, D., Yoshida, Y., & Kushimoto, S. (2017). Permissive hypotension/hypotensive resuscitation and restricted/controlled resuscitation in patients with severe trauma. Journal of Intensive Care, 5(1), 11. https://doi.org/10.1186/s40560-016-0202-z
Larson, N. J., Rogers, F. B., Feeken, J. L., Blondeau, B., & Dries, D. J. (2024). Electrolyte Disorders: Causes, Diagnosis, and Initial Care-Part 1. Air Medical Journal, 43(2), 80–83. https://doi.org/10.1016/j.amj.2024.01.001
Levy, M. J., Garfinkel, E. M., May, R., Cohn, E., Tillett, Z., Wend, C., Sikorksi, R. A., Troncoso, R., Jenkins, J. L., Chizmar, T. P., & Margolis, A. M. (2024). Implementation of a prehospital whole blood program: Lessons learned. Journal of the American College of Emergency Physicians Open, 5(2), e13142. https://doi.org/10.1002/emp2.13142
Ley, E. J., Clond, M. A., Srour, M. K., Barnajian, M., Mirocha, J., Margulies, D. R., & Salim, A. (2011). Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients. The Journal of Trauma, 70(2), 398–400. https://doi.org/10.1097/TA.0b013e318208f99b
Long, B., Liang, S. Y., & Gottlieb, M. (2023). Crush injury and syndrome: A review for emergency clinicians. The American Journal of Emergency Medicine, 69, 180–187. https://doi.org/10.1016/j.ajem.2023.04.029
National Model EMS Clinical Guidelines. (2022). NASEMSO National Association of State EMS Officials.
Olander, A., Andersson, H., Sundler, A. J., Bremer, A., Ljungström, L., & Andersson Hagiwara, M. (2019). Prehospital characteristics among patients with sepsis: A comparison between patients with or without adverse outcome. BMC Emergency Medicine, 19(1), 43. https://doi.org/10.1186/s12873-019-0255-0
PLASMA-LYTE 148 (An Electrolyte Solution) Injection/ PLASMA-LYTE A (An Electrolyte Solution) Injection. (n.d.). Baxter. Retrieved April 12, 2024, from chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.baxter.ca/sites/g/files/ebysai1431/files/2018-11/Plasma-Lyte_EN.pdf
Pliakas, J. (2017a). EMS Pharmacology Reference Guide.
Pliakas, J. (2017b). EMS Pharmacology Reference Guide.
Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care. (2022). Rural Health Research Center University of Washington. https://www.ruralhealthresearch.org/publications/1496
Prehospital Trauma Life Support (10th ed.). (2023). National Association of Emergency Medical Technicians.
Qian, Q. (2019). Hypernatremia. Clinical Journal of the American Society of Nephrology: CJASN, 14(3), 432–434. https://doi.org/10.2215/CJN.12141018
Rajasekaran, A., Bade, N., Cutter, G. R., Rizk, D. V., & Zarjou, A. (2022). Lactated Ringer’s solution and risk of hyperkalemia in patients with reduced kidney function. The American Journal of the Medical Sciences, 364(4), 433–443. https://doi.org/10.1016/j.amjms.2022.04.024
Ramesh, G. H., Uma, J. C., & Farhath, S. (2019). Fluid resuscitation in trauma: What are the best strategies and fluids? International Journal of Emergency Medicine, 12(1), 38. https://doi.org/10.1186/s12245-019-0253-8
Ravi, P. R., & Puri, B. (2017). Fluid resuscitation in haemorrhagic shock in combat casualties. Disaster and Military Medicine, 3, 2. https://doi.org/10.1186/s40696-017-0030-2
Rogenes, P. R., & Moylan, J. A. (1976). Restoring Fluid Balance in the Patient with Severe Burns. The American Journal of Nursing, 76(12), 1953–1957. https://doi.org/10.2307/3424042
Rudloff, E., & Hopper, K. (2021). Crystalloid and Colloid Compositions and Their Impact. Frontiers in Veterinary Science, 8, 639848. https://doi.org/10.3389/fvets.2021.639848
Rumbus, Z., Toth, E., Poto, L., Vincze, A., Veres, G., Czako, L., Olah, E., Marta, K., Miko, A., Rakonczay, Z., Balla, Z., Kaszaki, J., Foldesi, I., Maleth, J., Hegyi, P., & Garami, A. (2018). Bidirectional Relationship Between Reduced Blood pH and Acute Pancreatitis: A Translational Study of Their Noxious Combination. Frontiers in Physiology, 9, 1360. https://doi.org/10.3389/fphys.2018.01360
Saraghi, M. (2015). Intraoperative Fluids and Fluid Management for Ambulatory Dental Sedation and General Anesthesia. Anesthesia Progress, 62(4), 168–176; quiz 177. https://doi.org/10.2344/0003-3006-62.4.168
Self, W. H., Semler, M. W., Wanderer, J. P., Ehrenfeld, J. M., Byrne, D. W., Wang, L., Atchison, L., Felbinger, M., Jones, I. D., Russ, S., Shaw, A. D., Bernard, G. R., & Rice, T. W. (2017). Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: Study protocol for a cluster-randomized, multiple-crossover trial. Trials, 18, 178. https://doi.org/10.1186/s13063-017-1923-6
Semler, M. W., & Kellum, J. A. (2019). Balanced Crystalloid Solutions. American Journal of Respiratory and Critical Care Medicine, 199(8), 952–960. https://doi.org/10.1164/rccm.201809-1677CI
Shaheen, N. A., Alqahtani, A. A., Assiri, H., Alkhodair, R., & Hussein, M. A. (2018). Public knowledge of dehydration and fluid intake practices: Variation by participants’ characteristics. BMC Public Health, 18(1), 1346. https://doi.org/10.1186/s12889-018-6252-5
Shi, J., Tan, L., Ye, J., & Hu, L. (2020). Hypertonic saline and mannitol in patients with traumatic brain injury: A systematic and meta-analysis. Medicine, 99(35), e21655. https://doi.org/10.1097/MD.0000000000021655
Singh, S., Kerndt, C. C., & Davis, D. (2024). Ringer’s Lactate. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK500033/
Smith, M. (2008). Monitoring intracranial pressure in traumatic brain injury. Anesthesia and Analgesia, 106(1), 240–248. https://doi.org/10.1213/01.ane.0000297296.52006.8e
Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C., Mullins, T., & Sherrill, D. (2017). The Impact of Combined Prehospital Hypotension and Hypoxia on Mortality in Major Traumatic Brain Injury. Annals of Emergency Medicine, 69(1), 62–72. https://doi.org/10.1016/j.annemergmed.2016.08.007
Sperry, J. L., Martin, M. J., Moore, E. E., Sava, J. A., Ciesla, D., Rizzo, A. G., Brown, C., Brasel, K., Kozar, R., Vercruysse, G., & Inaba, K. (2019). Prehospital resuscitation in adult patients following injury: A Western Trauma Association critical decisions algorithm. The Journal of Trauma and Acute Care Surgery, 87(5), 1228–1231. https://doi.org/10.1097/TA.0000000000002488
Stiver, S. I., & Manley, G. T. (2008). Prehospital management of traumatic brain injury. Neurosurgical Focus, 25(4), E5. https://doi.org/10.3171/FOC.2008.25.10.E5
Sun, Y., Jin, J., Zhu, A., Hu, H., Lu, Y., Zeng, Y., & Jing, D. (2022). Risk Factors for Recurrent Pancreatitis After First Episode of Acute Pancreatitis. International Journal of General Medicine, 15, 1319–1328. https://doi.org/10.2147/IJGM.S344863
Susanto, M., & Riantri, I. (2022). Optimal Dose and Concentration of Hypertonic Saline in Traumatic Brain Injury: A Systematic Review. Medeniyet Medical Journal, 37(2), 203–211. https://doi.org/10.4274/MMJ.galenos.2022.75725
Ter Avest, E., Taylor, S., Wilson, M., & Lyon, R. L. (2021). Prehospital clinical signs are a poor predictor of raised intracranial pressure following traumatic brain injury. Emergency Medicine Journal: EMJ, 38(1), 21–26. https://doi.org/10.1136/emermed-2020-209635
Tommasino, C. (2002). Fluids and the neurosurgical patient. Anesthesiology Clinics of North America, 20(2), 329–346. https://doi.org/10.1016/S0889-8537(01)00013-X
Yazer, M. H., Spinella, P. C., Bank, E. A., Cannon, J. W., Dunbar, N. M., Holcomb, J. B., Jackson, B. P., Jenkins, D., Levy, M., Pepe, P. E., Sperry, J. L., Stubbs, J. R., & Winckler, C. J. (2022). THOR-AABB Working Party Recommendations for a Prehospital Blood Product Transfusion Program. Prehospital Emergency Care, 26(6), 863–875. https://doi.org/10.1080/10903127.2021.1995089
Zornow, M. H., & Prough, D. S. (1995). Fluid management in patients with traumatic brain injury. New Horizons (Baltimore, Md.), 3(3), 488–498.