de Crescenzo C, Gorouhi F, Salcedo ES, Galante JM.; J Trauma Acute Care Surg. 2017 Mar 2.

BACKGROUND: Prehospital assessment of a patient's circulation status and appropriate resuscitation with intravenous fluids plays a critical role in patients with obvious hemorrhage or systolic blood pressure below 90 mmHg.

OBJECTIVES: We assessed the efficacy and safety of prehospital administration of crystalloids, or colloids to improve the survival rate of trauma patients with acceptable safety profile.

DATA SOURCES: We searched SCOPUS, Embase, TRIP database, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and PubMed as per search protocol from 1 January 1900 to 12 February 2015.

STUDY ELIGIBILITY CRITERIA: all randomized controlled trials were considered. PARTICIPANTS, AND INTERVENTIONS: all patient with penetrating or blunt trauma excluding traumatic brain or thermal injuries. At least one of the comparators should be a crystalloid or colloid.

STUDY APPRAISAL AND SYNTHESIS METHODS: detailed search strategy was developed and utilized. Duplicates were removed from the search results. The co-first authors independently reviewed the article titles and abstracts to assess eligibility. Eligible articles were downloaded for full text review to determine inclusion in the review and analysis. Co-first authors performed a methodological quality assessment of each included article. The primary outcome was mortality. The secondary outcomes included adverse events, infections, multiple organ dysfunction score and length of stay at the hospital. Heterogeneity was measured by I value. An I value greater than 50% was considered to be substantial heterogeneity. Fixed-effect analysis and Random-effect analysis were performed when needed.

RESULTS: A total of 9 trials (3490 patients) were included in the systematic review and 6 trials in meta-analyses. There were no significant difference between HSD and LR in one day using two studies (2.91 [95% CI, 0.58-14.54, P = 0.19]) and 28-30 day survival rates using another two studies (1.47 [95% CI, 0.30-7.18, P = 0.63]). Adding dextran to hypertonic saline did not increase the survival rate (0.94 [95% CI, 0.65-1.34, P = 0.71]). Overall, complications were comparable between all groups.

LIMITATIONS: the quality of some of the included studies is not optimal.

CONCLUSIONS: There is no beneficial effect of hypertonic saline with or without dextran in general traumatic patients. Further trials to evaluate its benefit in patients with penetrating trauma requiring surgery is warranted.

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