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


CONCLUSIONS
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.


METHODS
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.
Samuel W
SW
Ross
A Britton
AB
Christmas
Peter E
PE
Fischer
Haley
H
Holway
Amanda L
AL
Walters
Rachel
R
Seymour
Michael A
MA
Gibbs
B Todd
BT
Heniford
Ronald F
RF
Sing
D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001782:Blood Donors; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D064368:Healthy Volunteers; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use*; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011446:Prospective Studies; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000628:therapy*; D012965:Sodium Chloride / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D015415:Biomarkers; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D007773:Lactates; D000077325:Ringer's Lactate; D012965:Sodium Chloride