Impact of the utilization of 500 mL IV bags on crystalloid resuscitation volumes administered to trauma patients.

INTRODUCTION: Administering large volumes of crystalloids to trauma patients has been shown to exacerbate metabolic complications of hemorrhage including dilutional coagulopathy and worsening acidosis The aim of this study was to evaluate crystalloid administration volumes in trauma patients after replacing 1 L IV containers with 500 mL IV containers in the emergency department trauma resuscitation bay. MATERIALS AND METHODS: This was a single-center, IRB-approved, retrospective cohort evaluation of adult trauma patients conducted at an 864-bed community tertiary referral center located in the southeastern United States. Patterns of crystalloid administration were examined before and after the trauma resuscitation bay began to exclusively stock 500 mL IV containers. The primary outcome was mean total crystalloid volume infused from time of injury to hospital admission. Secondary outcomes included mean total crystalloid volume infused prior to administration of blood products, proportion of patients who received less than 2 L total of crystalloids, time to initiation of blood products, and mortality in both the emergency department and in-hospital. RESULTS: Patient characteristics were largely similar between both groups including age, mechanism of injury, and Injury Severity Score. For the primary outcome, the mean total crystalloid volume infused from time of injury to hospital administration, patients in the 500 mL IV fluid container group were administered 555 mL less crystalloid when compared to the 1 L IV fluid container group, 1048 mL vs 1603 mL (p < 0.01; 95% CI 406 mL - 704 mL), respectively. After conversion to the 500 mL IV container bags, there was a 27.5% increase in the proportion of patients receiving less than 2 L of crystalloid, 90.5% vs 63.0% in the 500 mL IV fluid container and 1 L IV fluid container groups, respectively (p < 0.01). CONCLUSIONS: Due to reduced mortality, expanding literature and guidelines clearly support minimizing IV crystalloid resuscitation. Institutions must now work to minimize use of IV crystalloids to hemorrhaging trauma patients and a simple solution of using smaller IV fluid bags was shown to improve adherence to this practice.

Impact of Early Tranexamic Acid Administration on Overall Blood Product Utilization at 24 Hours.

Antifibrinolytics have demonstrated a mortality benefit in trauma patients when utilized early after injury. In line with recent literature, the authors hypothesize that early tranexamic acid (TXA) administration will decrease overall blood product administration at 24 hr. This is a retrospective cohort evaluation of 65 trauma patients admitted and discharged between May 1, 2015, and December 31, 2017, who received packed red blood cells (PRBCs) and TXA within 3 hr following injury. The primary outcome was overall PRBC utilization at 24 hr when TXA was administered less than 1 hr of injury compared with 1-3 hr of injury. A subgroup analysis compared PRBC usage at 24 hr when PRBC to TXA administration time was less than 30 min compared with 30 min or more. During the study time, 15 patients received TXA early, less than 1 hr from injury, and 50 patients received TXA within 1-3 hr of injury. Patients received a median of 7 units of PRBCs in the early group and 8 units in the standard group (p = .64) at 24 hr. Patients who received TXA less than 30 min after first PRBC received a median of 6 units at 24 hr compared with 9 units when PRBC to TXA time was 30 min or more (p = .014). There was no difference in PRBCs at 24 hr in patients who received TXA early compared with 1-3 hr from injury. There was a significant increase in PRBC requirement at 24 hr when patients received TXA 30 min or more from first PRBC. Further inquiry into the optimal timing of TXA administrated is needed.