Prehospital fluid resuscitation

Trauma and associated major blood losses in Germany represent the leading cause of mortality in patients up to 45 years of age. The endpoints of prehospital fluid resuscitation in traumatic-hemorrhagic shock are the restitution of intravascular volume und cardiac preload, in order to increase cardiac output and thus provide adequate oxygen delivery to the tissues. The key therapeutic factor to prevent the development of multiple organ failure complicating trauma and shock, however, is the normalization not only of macrohemodynamics (systemic blood pressure, cardiac output), but the restitution of the disturbed microvascular perfusion. In case of major blood loss and exsanguination this can not be achieved by crystalloids and synthetic colloids used in conventional volume therapy. A new concept consists of i.v. bolus in fusion of a small volume (4 ml/kg body weight) of a hyperosmolar (7,2-7,5%) NaCl/colloid solution, which is termed ''Small-volume Resuscitation''. Recently presented data from a cohort analysis of 8 preclinical studies show an increase in survival rate by about 5% when compared to standard of care. In addition, artificial oxygen carrying solutions are currently investigated, by which - through an increase of O-2-blood content - oxygen delivery to the tissues might be augmented.