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International Journal of Emergency Medicine

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Open Access 01-12-2023 | Shock | Research

Volume replacement in the resuscitation of trauma patients with acute hemorrhage: an umbrella review

Authors: Silvia Gianola, Greta Castellini, Annalisa Biffi, Gloria Porcu, Antonello Napoletano, Daniela Coclite, Daniela D’Angelo, Marco Di Nitto, Alice Josephine Fauci, Ornella Punzo, Primiano Iannone, Osvaldo Chiara, the Italian National Institute of Health guideline working group

Published in: International Journal of Emergency Medicine | Issue 1/2023

Abstract

Background

The use of intravenous fluid therapy in patients with major trauma in prehospital settings is still controversial. We conducted an umbrella review to evaluate which is the best volume expansion in the resuscitation of a hemorrhagic shock to support the development of major trauma guideline recommendations.

Methods

We searched PubMed, Embase, and CENTRAL up to September 2022 for systematic reviews (SRs) investigating the use of volume expansion fluid on mortality and/or survival. Quality assessment was performed using AMSTAR 2 and the Certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results

We included 14 SRs investigating the effects on mortality with the comparisons: use of crystalloids, blood components, and whole blood. Most SRs were judged as critically low with slight overlapping of primary studies and high consistency of results. For crystalloids, inconsistent evidence of effectiveness in 28- to 30-day survival (primary endpoint) was found for the hypertonic saline/dextran group compared with isotonic fluid solutions with moderate certainty of evidence. Pre-hospital blood component infusion seems to reduce mortality, however, as the certainty of evidence ranges from very low to moderate, we are unable to provide evidence to support or reject its use. The blood component ratio was in favor of higher ratios among all comparisons considered with moderate to very low certainty of evidence. Results about the effects of whole blood are very uncertain due to limited and heterogeneous interventions in studies included in SRs.

Conclusion

Hypertonic crystalloid use did not result in superior 28- to 30-day survival. Increasing evidence supports the scientific rationale for early use of high-ratio blood components, but their use requires careful consideration. Preliminary evidence is very uncertain about the effects of whole blood and further high-quality studies are required.

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Title: Volume replacement in the resuscitation of trauma patients with acute hemorrhage: an umbrella review
Authors: Silvia Gianola
Greta Castellini
Annalisa Biffi
Gloria Porcu
Antonello Napoletano
Daniela Coclite
Daniela D’Angelo
Marco Di Nitto
Alice Josephine Fauci
Ornella Punzo
Primiano Iannone
Osvaldo Chiara
the Italian National Institute of Health guideline working group
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Shock
Shock
Volume Replacement
Published in: International Journal of Emergency Medicine / Issue 1/2023
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/s12245-023-00563-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Volume replacement in the resuscitation of trauma patients with acute hemorrhage: an umbrella review

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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