title: Prehospital volume resuscitation--Did evidence defeat the crystalloid dogma? An analysis of the TraumaRegister DGU® 2002-2012.
abstract: BACKGROUND
  Various studies have shown the deleterious effect of high volume resuscitation following severe trauma promoting coagulopathy by haemodilution, acidosis and hypothermia. As the optimal resuscitation strategy during prehospital trauma care is still discussed, we raised the question if the amount and kind of fluids administered changed over the recent years. Further, if less volume was administered, fewer patients should have arrived in coagulopathic depletion in the Emergency Department resulting in less blood product transfusions.
  
  
  METHODS
  A data analysis of the 100 489 patients entered into the TraumaRegister DGU® (TR-DGU) between 2002 and 2012 was performed of which a total of 23512 patients (23.3%) matched the inclusion criteria. Volume and type of fluids administered as well as outcome parameter were analysed.
  
  
  RESULTS
  Between 2002 and 2012, the amount of volume administered during prehospital trauma care decreased from 1790 ml in 2002 to 1039 ml in 2012. At the same time higher haemoglobin mean values, higher Quick's mean values and reduced mean aPTT can be observed. Simultaneously, more patients received catecholamines (2002: 9.2 to 2012: 13.0%). Interestingly, the amount of volume administered decreased steadily regardless of the presence of shock. Fewer patients were in the need of blood products and the number of massive transfusions (≥10 pRBC) more than halved.
  
  
  CONCLUSIONS
  The changes in volume therapy might have reduced haemodilution potentially resulting in an increase of the Hb value. During the period observed transfusion strategies have become more restrictiveand ratio based; the percentage of patients receiving MT halved as blood products may imply negative secondary effects. Furthermore, preventing administration of high blood product ratios result in less impairment of coagulation factors and inhibitors and an therfore improved coagulation.
  
  
  CONCLUSIONS
  The volume administered in severely injured patients decreased considerably during the last decade possibly supporting beneficial effects such as minimizing the risk of coagulopathy and avoiding potential harmful effects caused by blood product transfusions. Despite outstanding questions in trauma resuscitation, principle evidence merges quickly into clinical practice and algorithms.
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. arne.driessen@gmx.de.|Department of Medicine, Institute for Research in Operative Medicine, Faculty of Health, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. arne.driessen@gmx.de.
authors.forename: Arne
authors.initials: A
authors.lastname: Driessen
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. froehlichm@kliniken-koeln.de.|Department of Medicine, Institute for Research in Operative Medicine, Faculty of Health, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. froehlichm@kliniken-koeln.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Fröhlich
authors.affiliation: Department of Medicine, Institute for Research in Operative Medicine, Faculty of Health, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schäfer
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Mutschler
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Defosse
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brockamp
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.affiliation: Department of Medicine, Institute for Research in Operative Medicine, Faculty of Health, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
authors.forename: Ewa K
authors.initials: EK
authors.lastname: Stürmer
authors.affiliation: Department of Medicine, Institute for Research in Operative Medicine, Faculty of Health, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
mesh_terms: D000328:Adult; D000077324:Crystalloid Solutions; D004632:Emergency Medical Services; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000503:physiopathology
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: Coagulopathy; Colloids; Crystalloids; Hyperoncotic fluids; Massive transfusion; Pre-hospital volume administration; Trauma care