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Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting.
Yost, Mark T; Driban, Matt; Dissak Delon, Fanny Nadia; Mbianyor, Mbiarikai A; Kinge, Thompson; Njock, Richard; Nkusu, Daniel; Tsiagadigui, Jean-Gustave; Carvalho, Melissa; Oke, Rasheedat; Chichom-Mefire, Alain; Juillard, Catherine; Christie, S Ariane.
Afiliación
  • Yost MT; Department of Surgery, University of California Los Angeles, Los Angeles, California, USA.
  • Driban M; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
  • Dissak Delon FN; University of Bamenda, Bamenda, Cameroon.
  • Mbianyor MA; Faculty of Health Sciences, University of Buea, Buea, Cameroon.
  • Kinge T; Limbe Regional Hospital, Limbe, Cameroon.
  • Njock R; Laquintinie Hospital, Douala, Cameroon.
  • Nkusu D; Catholic Hospital of Pouma, Pouma, Cameroon.
  • Tsiagadigui JG; Edea Regional Hospital, Edea, Cameroon.
  • Carvalho M; Department of Surgery, University of California Los Angeles, Los Angeles, California, USA.
  • Oke R; Department of Surgery, University of California Los Angeles, Los Angeles, California, USA.
  • Chichom-Mefire A; Faculty of Health Sciences, University of Buea, Buea, Cameroon.
  • Juillard C; Department of Surgery, University of California Los Angeles, Los Angeles, California, USA.
  • Christie SA; Department of Surgery, University of California Los Angeles, Los Angeles, California, USA.
Trauma Surg Acute Care Open ; 9(1): e001290, 2024.
Article en En | MEDLINE | ID: mdl-38616791
ABSTRACT

Objectives:

We analyzed resuscitation practices in Cameroonian patients with trauma as a first step toward developing a context-appropriate resuscitation protocol. We hypothesized that more patients would receive crystalloid-based (CB) resuscitation with a faster time to administration than blood product (BL) resuscitation.

Methods:

We included patients enrolled between 2017 and 2019 in the Cameroon Trauma Registry (CTR). Patients presenting with hemorrhagic shock (systolic blood pressure (SBP) <100 mm Hg and active bleeding) were categorized as receiving CB, BL, or no resuscitation (NR). We evaluated differences between cohorts with the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. We compared time to treatment with the Wilcoxon rank sum test.

Results:

Of 9635 patients, 403 (4%) presented with hemorrhagic shock. Of these, 278 (69%) patients received CB, 39 (10%) received BL, and 86 (21%) received NR. BL patients presented with greater injury severity (Highest Estimated Abbreviated Injury Scale (HEAIS) 4 BL vs 3 CB vs 1 NR, p<0.001), and lower median hemoglobin (8.0 g/dL BL, 11.4 g/dL CB, 10.6 g/dL NR, p<0.001). CB showed greater initial improvement in SBP (12 mm Hg CB vs 9 mm Hg BL vs 0 NR mm Hg, p=0.04) compared with BL or no resuscitation, respectively. Median time to treatment was lower for CB than BL (12 vs 131 min, p<0.01). Multivariate logistic regression adjusted for injury severity found no association between resuscitation type and mortality (CB adjusted OR (aOR) 1.28, p=0.82; BL aOR 1.05, p=0.97).

Conclusions:

CB was associated with faster treatment, greater SBP elevation, and similar survival compared with BL in Cameroonian patients with trauma with hemorrhagic shock. In blood-constrained settings, treatment delays associated with blood product transfusion may offset the physiologic benefits of an early BL strategy. CB prior to definitive hemorrhage control in this resource-limited setting may be a necessary strategy to optimize perfusion pressure. Level of evidence and study type III, retrospective study.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Trauma Surg Acute Care Open Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Trauma Surg Acute Care Open Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido