Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting
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 pro...
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BMJ Publishing Group
2024-07-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001290.full |
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| author | Melissa Carvalho Alain Chichom-Mefire Catherine Juillard S Ariane Christie Rasheedat Oke Thompson Kinge Jean-Gustave Tsiagadigui Mbiarikai A Mbianyor Mark T Yost Matt Driban Fanny Nadia Dissak Delon Richard Njock Daniel Nkusu |
| author_facet | Melissa Carvalho Alain Chichom-Mefire Catherine Juillard S Ariane Christie Rasheedat Oke Thompson Kinge Jean-Gustave Tsiagadigui Mbiarikai A Mbianyor Mark T Yost Matt Driban Fanny Nadia Dissak Delon Richard Njock Daniel Nkusu |
| author_sort | Melissa Carvalho |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-941f29224b454599abd5677946ff8748 |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-941f29224b454599abd5677946ff87482025-01-24T10:15:09ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-07-019110.1136/tsaco-2023-001290Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained settingMelissa Carvalho0Alain Chichom-Mefire1Catherine Juillard2S Ariane Christie3Rasheedat Oke4Thompson Kinge5Jean-Gustave Tsiagadigui6Mbiarikai A Mbianyor7Mark T Yost8Matt Driban9Fanny Nadia Dissak Delon10Richard Njock11Daniel Nkusu12Department of Surgery, University of California Los Angeles, Los Angeles, California, USAFaculty of Health Sciences, University of Buea, Buea, CameroonProgram for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California, Los Angeles, California, USADepartment of Surgery, University of California Los Angeles, Los Angeles, California, USAProgram for the Advancement of Surgical Equity (PASE), Department of Surgery, University of California, Los Angeles, California, USALimbe Regional Hospital, Limbe, CameroonEdea Regional Hospital, Edea, CameroonFaculty of Health Sciences, University of Buea, Buea, CameroonDepartment of Surgery, University of California Los Angeles, Los Angeles, California, USAUniversity of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USAUniversity of Bamenda, Bamenda, CameroonLaquintinie Hospital, Douala, CameroonCatholic Hospital of Pouma, Pouma, CameroonObjectives 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.https://tsaco.bmj.com/content/9/1/e001290.full |
| spellingShingle | Melissa Carvalho Alain Chichom-Mefire Catherine Juillard S Ariane Christie Rasheedat Oke Thompson Kinge Jean-Gustave Tsiagadigui Mbiarikai A Mbianyor Mark T Yost Matt Driban Fanny Nadia Dissak Delon Richard Njock Daniel Nkusu Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting Trauma Surgery & Acute Care Open |
| title | Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting |
| title_full | Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting |
| title_fullStr | Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting |
| title_full_unstemmed | Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting |
| title_short | Crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood-constrained setting |
| title_sort | crystalloid resuscitation is associated with decreased treatment delays and improved systolic blood pressures in a blood constrained setting |
| url | https://tsaco.bmj.com/content/9/1/e001290.full |
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