Rapid Resuscitation with Small Volume Hypertonic Saline Solution for Patients in Traumatic Haemorrhagic Shock

Abstract

Background: Haemorrhagic shock is a major cause of morbidity and mortality worldwide. Trauma and its complications account for one in ten deaths worldwide and are the leading cause of death in those below 45 years of age in developed countries. Survival of the shocked patient is influenced by the speed and efficiency with which resuscitation is carried out. Rapid infusion of a small volume of 7.5% hypertonic saline (HSS) has been shown to result in immediate restoration of circulating volume and tissue perfusion but results of investigation of its use remain inconclusive. The objective of this study was to determine the clinical outcomes of infusing locally made 7.5% HSS in patients with haemorrhagic shock.

Methods: During a six-month period, all adult trauma patients coming to the casualty with haemorrhagic shock were enrolled into the study. A detailed clinical assessment was performed, and respiratory and cardiovascular vital signs were recorded. Five millilitres of venous blood was drawn for determination of Haematocrit, haemoglobin, serum electrolytes and creatinine. A rapid infusion of 250mls of HSS was given intravenously followed three to five minutes later by recording the vital signs again and drawing another 5 mls of blood for a repeat of the laboratory tests. Recovery from shock was followed by standard fluid infusion. Additional or alternative resuscitation and other therapeutic measures were taken as indicated. Recording of the vital signs was continued at four hourly intervals for 24 hours. The data were entered into a computer data base and analysed.

Results: Forty five patients were enrolled and resuscitated with 250 mls 7.5% HSS. Among the studied patients, 88.9% recovered from shock immediately after being infused with 7.5% HSS. Of patients with a single injury, 96.6% recovered from shock whereas only 75% of those with multiple injuries recovered. Eighty percent of patients survived beyond 24 hours post resuscitation. While 93.1% of patients with a single injury survived beyond 24 hours, only 56.3% of those who sustained multiple injuries did so.

Conclusion: Rapid resuscitation with HSS has demonstrated clinical benefits in initial treatment of traumatic hemorrhagic shock in patients admitted to the emergency room. Further investigation of the effects of HSS resuscitation is warranted.