The resuscitative fluid you choose may potentiate bleeding

Area of Science:

• Trauma and Emergency Medicine
• Hematology
• Physiology

Background:

• Trauma is a leading cause of death in the US, often due to hemorrhagic shock.
• Optimal fluid resuscitation strategies for hemorrhagic shock remain debated.
• The impact of resuscitation fluids on the coagulation cascade is not well understood.

Purpose of the Study:

• To investigate the effects of different fluid resuscitation formulas on blood coagulation.
• To compare the impact of 0.9% NaCl, lactated Ringer's, 6% hydroxyethyl starch, and 3% NaCl on thrombin generation, fibrin formation, and platelet activation.
• To evaluate these effects across a range of blood dilutions (0-75%).

Main Methods:

• A novel whole blood model was utilized under controlled conditions.
• Thrombin generation was measured over 20 minutes.
• Platelet activation and fibrinopeptide A (FPA) release were assessed at 20 minutes.
• Fibrin clot mass was determined.
• Four diluents were tested: 0.9% NaCl (NS), lactated Ringer's (LR), 6% hydroxyethyl starch (HES), and 3% NaCl (HS).

Main Results:

• Coagulation markers showed significant differences based on both dilution and diluent.
• NS and LR demonstrated the least inhibition of thrombin generation, platelet activation, and FPA release.
• 3% NaCl (HS) caused the most significant disruption, with no coagulation observed at 30-75% dilution.
• 6% hydroxyethyl starch (HES) also markedly reduced coagulation markers and fibrin clot mass, especially at higher dilutions.
• Stable fibrin clots were maintained at 10-20% dilution with NS and LR, but not with HES and HS.

Conclusions:

• Lactated Ringer's (LR) and 0.9% NaCl (NS) exhibit the least detrimental effects on coagulation parameters compared to HES and HS.
• Volume expanders like HES and HS may be disadvantageous in managing hemorrhagic shock.
• Further research is warranted to elucidate the clinical implications of these findings in trauma resuscitation.