Clinical trial of an emergency resuscitation algorithm

Clinical trials of a resuscitation algorithm for patients entering the Surgical Emergency Department (ED) with acute hypotension were conducted for a 30-month period. The intent was not to compare good management with bad, but rather university-run county hospital services with and without an algorithm. The study group was comprised of 603 hypotensive patients out of 6833 consecutive admissions. The effects of the policy of using a resuscitation algorithm were evaluated by the outcomes of the patients who were treated by residents given the algorithm (protocol group) versus those treated by residents not given the algorithm (control group). The efficacy of the algorithm, per se, was evaluated by outcomes of patients whose management was in satisfactory compliance with the algorithm as compared with those whose management deviated from the algorithm. The patients were also evaluated by the primary cause of their hypotension and the presence of severe associated illnesses. Outcomes of patients treated by residents given the algorithm were as good and in a number of respects better than those of patients treated by residents without the algorithm. The mean resuscitation time of the protocol group was markedly and significantly less than that of the control group indicating that the policy of using the algorithm facilitated resuscitation even though it was not always properly followed. Patients with trauma, hemorrhage, and sepsis, whose care was in satisfactory compliance with the algorithm had shorter resuscitation times, lower MAP-time deficits, and less shock-related complications. The algorithm which is primarily directed toward fluid resuscitation did not appear to be efficacious for patients whose trauma was primarily head injury, where fluid restriction may be the therapy of choice.