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Impact of common crystalloid solutions on resuscitation markers following Class I hemorrhage: A randomized control trial

Ross, Samuel W. MD, MPH; Christmas, A. Britton MD; Fischer, Peter E. MD, MS; Holway, Haley BS; Walters, Amanda L. MS; Seymour, Rachel PhD; Gibbs, Michael A. MD; Heniford, B. Todd MD; Sing, Ronald F. DO

Journal of Trauma and Acute Care Surgery: November 2015 - Volume 79 - Issue 5 - p 732–740
doi: 10.1097/TA.0000000000000833
EAST 2015 Plenary Papers

BACKGROUND Resuscitation after hemorrhage with crystalloid solutions can lead to marked acidosis and iatrogenically worsen the lethal triad. The effect of differing solutions on base deficit and lactate has been sparsely prospectively studied in humans. We sought to quantify the effect of normal saline (NS) and lactated Ringer’s (LR) resuscitation in voluntary blood donors as a model for Class I hemorrhage.

METHODS A prospective randomized control trial was conducted in conjunction with blood drives. Donors were randomized to receive no intravenous fluid (noIVF), 2-L NS, or 2-L LR after blood donation of 500 mL. Lactate and base deficit were measured before and after fluid administration using an iSTAT. The mean laboratory values were compared between groups first using a global test followed by pairwise testing between groups using the Wilcoxon rank-sum and Kruskal-Wallis tests. The Bonferroni correction was used and a statistical significance of p < 0.0167 was set.

RESULTS A total of 157 patients completed the study. The mean (SD) age was 39.2 (12.7), and 65.0% were female. Patients in each group lost equivalent amounts of total blood volume, and a similar amount was replaced in the crystalloid group (p > 0.0167). Donors had comparable increases in lactate and base deficit after donation regardless of the group (p > 0.0167). After resuscitation with 2-L crystalloid, the lactate level increased higher in the LR group than in the noIVF or the NS group (1.36 mmol/L vs. 1.00 mmol/L vs. 1.54 mmol/L, p < 0.0001). In addition, the resuscitation base deficit increased in the NS group more than in the noIVF or LR group (−0.65 vs. −3.06 vs. −0.34, p < 0.0001).

CONCLUSION This study is one of the first human studies to prospectively demonstrate quantifiable differences in base deficit and lactate by type of crystalloid resuscitation. LR resuscitation elevated lactate levels, and NS negatively affected the base deficit. These findings are critical to the interpretation of trauma patient resuscitation with crystalloid solutions.

LEVEL OF EVIDENCE Therapeutic study, level II.

From the Departments of General Surgery (S.W.R., A.B.C., P.E.F., H.H., A.L.W., B.T.H., R.F.S.), Orthopedic Surgery (R.S.), and Emergency Medicine (M.A.G.), F.H. “Sammy” Ross, Jr. Trauma Center, Carolinas Medical Center, Charlotte, North Carolina.

Submitted: December 17, 2014, Revised: July 3, 2015, Accepted: July 9, 2015.

This study was presented at the 28th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January 13–17, 2015, in Lake Buena Vista, Florida. Winner of the Raymond H. Alexander Resident Paper Competition in clinical sciences.

Approved by Carolinas HealthCare System IRB#: 08-08-19E.

National Clinical Trials Identifier: NCT02318355, Proving Hemodilution in a Human Model for Class I Hemorrhage.

Address for reprints: Ronald F. Sing DO, 1000 Blythe Blvd, MEB 601, Charlotte, NC 28203; email:

© 2015 Lippincott Williams & Wilkins, Inc.