Strategies for trauma resuscitation

Victims of penetrating trauma often arrive at a trauma center within minutes of sustaining their injury but nevertheless are in a state of deep circulatory shock. Such patients require extensive resuscitative efforts; in particular, some benefit from rapid, massive normothermic fluid resuscitation. During an initial one year period, 153 of 730 patients required immediate operation and, of these, 33 required rapid infusion defined as greater than 5 liters per hour during the first hour. The over-all survival rate of those operated upon was 79 per cent. Encouraged by these data, the rapid infusor (Level 1 H-500) (Level 1, Technologies, Inc.) was modified to further increase normothermic fluid delivery to 500 milliliters per minute. Eleven of the subsequent 205 patients required rapid infusion. There was a statistically significant improvement in clinical flow rates, decrement in resuscitation times and unexpected survival. In particular, the latter group (nine survivors) included four who were clinically dead in the field or on arrival at the trauma center, or both. Rapid infusion of normothermic fluids may be of benefit not only in penetrating trauma but also more generally in the management of massive hemorrhage.