A Prospective, Randomized, Multicenter Trial Comparing Lactated Ringer's Alone or With 5% Albumin for Resuscitation...

ABRUPT2 was a prospective, randomized, multicenter trial to determine whether lactated Ringer's + 5% albumin (Alb) reduces resuscitation requirements compared to lactated Ringer's (LR) alone in major burns.

The prospective, observational, multicenter ABRUPT study(1) found that initiation of albumin rapidly lowered fluid input and improved urine output in patients with burns ≥ 20% TBSA.

Based on the ABRUPT trial, inclusion was increased to ≥ 25% TBSA and ≥ 20% full-thickness. Patients ≥ 18 years were randomized to receive LR or Alb (2/3 LR + 1/3 5% albumin) for initial resuscitation. The initial rate was 2-4 ml/kg/% TBSA and adjusted to urine output (0.5-1 mL/kg/hour). For safety or excessive fluid volumes (> 250 mL/kg in 24 hours), investigators could crossover between assigned study arms.

The study was stopped at 99 subjects (Alb-48, LR-51) due to declining enrollment in 19/27 centers. Mean % TBSA burn was 46%. Twenty-six (51%) LR patients crossed over to Alb, but there were no crossovers from Alb to LR. Despite crossovers, following intention-to-treat, there were statistically significant (p 0.001) increased fluids at 24 and 48 hours for the LR group compared to Alb. The LR group averaged 1.5 (95% CI: 0.59,2.3) ml/kg/%TBSA and 2.1 (95% CI: 1.0,3.1) ml/kg/%TBSA times higher fluids compared to Alb at 24 and 48 hours, respectively. There were no differences in mortality, time to healing or acute kidney injury.

The use of 5% albumin significantly reduced fluid requirements compared to LR alone in the first 48 hours after injury.