Optimizing Fluid Resuscitation Strategies: A Network Meta-analysis of Effectiveness and Safety for Hemorrhagic Shock...

Hemorrhagic shock is a life-threatening condition and remains a leading cause of death worldwide. Current European guidelines lack recommendations for one fluid type over another in the management of hemorrhagic shock. This study explores the effectiveness and safety of colloids and crystalloids in resuscitation of hemorrhagic shock patients.

We conducted a systematic search in PubMed, Cochrane Cenral Register of Controlled Trials (CENTRAL), Scopus, Web of Science, ProQuest, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) up to January 3, 2024. We performed data analyses using Rstudio v.4.4.1 in Frequentist network meta-analysis with DerSimonian-Laird random-effects model. Subgroup and network meta-regression analyses was also performed in Bayesian methods. We analyzed safety aspects using meta-proportions with generalized linear mixed models models.

A total of 3,693 patients from 23 randomized controlled trials were included in this study. Synthetic colloid demonstrated the lowest mortality rate (odds ratio 0.37, 95% CI, 0.15-0.93; P-score = .94) with the lowest fluid input requirement (mean difference -1.02; 95% CI, -1.62 to -0.41; P-score = .75). Subgroup and network meta-regression analysis revealed none of the covariates significantly influenced these two outcomes. Regarding safety aspects, isotonic crystalloid caused the most diverse adverse events, with acute respiratory distress syndrome (prop = 0.067) and overload syndrome (prop = 0.063) being the most common adverse events.

This study provides robust evidence favoring the initial use of synthetic colloid in the management of patients with hemorrhagic shock.