title: Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care: TCCC Guidelines Change 14-01--2 June 2014.
abstract: This report reviews the recent literature on fluid resuscitation from hemorrhagic shock and considers the applicability of this evidence for use in resuscitation of combat casualties in the prehospital Tactical Combat Casualty Care (TCCC) environment. A number of changes to the TCCC Guidelines are incorporated: (1) dried plasma (DP) is added as an option when other blood components or whole blood are not available; (2) the wording is clarified to emphasize that Hextend is a less desirable option than whole blood, blood components, or DP and should be used only when these preferred options are not available; (3) the use of blood products in certain Tactical Field Care (TFC) settings where this option might be feasible (ships, mounted patrols) is discussed; (4) 1:1:1 damage control resuscitation (DCR) is preferred to 1:1 DCR when platelets are available as well as plasma and red cells; and (5) the 30-minute wait between increments of resuscitation fluid administered to achieve clinical improvement or target blood pressure (BP) has been eliminated. Also included is an order of precedence for resuscitation fluid options. Maintained as recommendations are an emphasis on hypotensive resuscitation in order to minimize (1) interference with the body's hemostatic response and (2) the risk of complications of overresuscitation. Hextend is retained as the preferred option over crystalloids when blood products are not available because of its smaller volume and the potential for long evacuations in the military setting.
authors.forename: Frank K
authors.initials: FK
authors.lastname: Butler
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
authors.forename: Russ S
authors.initials: RS
authors.lastname: Kotwal
authors.forename: Donald A
authors.initials: DA
authors.lastname: Jenkins
authors.forename: Howard R
authors.initials: HR
authors.lastname: Champion
authors.forename: F
authors.initials: F
authors.lastname: Bowling
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DuBose
authors.forename: Warren C
authors.initials: WC
authors.lastname: Dorlac
authors.forename: Gina R
authors.initials: GR
authors.lastname: Dorlac
authors.forename: Norman E
authors.initials: NE
authors.lastname: McSwain
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Timby
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Stockinger
authors.forename: Geir
authors.initials: G
authors.lastname: Strandenes
authors.forename: Richard B
authors.initials: RB
authors.lastname: Weiskopf
authors.forename: Kirby
authors.initials: K
authors.lastname: Gross
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bailey
mesh_terms: D016913:Blood Component Transfusion / Q000379:methods; D003102:Colloids / Q000627:therapeutic use*; D000077324:Crystalloid Solutions; D004638:Emergency Treatment; D058734:Exsanguination / Q000628:therapy*; D005440:Fluid Therapy / Q000379:methods*; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007552:Isotonic Solutions / Q000627:therapeutic use; D008887:Military Medicine / Q000592:standards; D008889:Military Personnel; D010952:Plasma Substitutes / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D014857:Warfare
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes