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Small-volume fluid resuscitation for the far-forward combat environment: current concepts
Michael A Dubick1, James L Atkins
1U.S. Army Institute of Surgical Research, San Antonio, Texas 78234-6315, USA. michael.dubick@amedd.army.mil
The Journal of Trauma
|May 28, 2003
Summary
Hypertonic saline dextran (HSD) shows promise as a small-volume resuscitation fluid for battlefield hemorrhage. This approach may improve survival rates for combat casualties facing delayed evacuation.
Area of Science:
- Military Medicine
- Trauma Resuscitation
- Emergency Medicine
Background:
- Hemorrhage is a leading cause of death in warfare.
- Delayed evacuation in modern combat necessitates improved field resuscitation strategies.
- Permissive hypotension is a key goal for treating severe hemorrhage.
Purpose of the Study:
- To evaluate limited-volume fluid resuscitation for battlefield hemorrhage.
- To assess hypertonic saline dextran (HSD) as a plasma volume expander.
- To improve survival and prevent complications in combat casualties.
Main Methods:
- Evaluation of hypertonic saline dextran (HSD) in animal models of hemorrhage.
- HSD administered at a fraction of conventional crystalloid volumes.
- Investigation of HSD under hypotensive resuscitation and intraosseous infusion.
Main Results:
- Hypertonic saline dextran (HSD) identified as a potentially useful field resuscitation fluid.
- HSD effective at significantly lower volumes than traditional fluids.
- Preliminary studies support HSD use in hypotensive resuscitation and intraosseous administration.
Conclusions:
- Limited-volume resuscitation with HSD offers a viable strategy for battlefield hemorrhage.
- HSD can overcome challenges associated with field fluid resuscitation.
- Findings have implications for optimizing combat casualty care under austere conditions.