Comparison of Standard and Alternative Prehospital Resuscitation in Uncontrolled Hemorrhagic Shock and Head Injury

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Abstract
Recently acquired data suggest that prehospital fluid resuscitation may worsen outcome of patients with penetrating torso trauma. In patients with head injury, delayed resuscitation (DR) could lead to secondary cerebral ischemia. We hypothesized that standard prehospital resuscitation (SPR) with lactated Ringer’s solution or diaspirin cross-linked hemoglobin would reduce secondary cerebral ischemia compared with DR. Anesthetized swine were randomized to receive SPR, diaspirin cross-linked hemoglobin, or DR after cryogenic brain injury and uncontrolled hemorrhagic shock and studied for 70 minutes after the combined insults. Hemorrhage volume was lowest in the DR group (pp In this model, SPR leads to secondary cerebral ischemia. DR is no worse and may be superior to conventional prehospital resuscitation with lactated Ringer’s solution.