What fluids are given during air ambulance treatment of patients with trauma in the UK, and what might this mean for the future? Results from the RESCUER observational cohort study
Naumann, David N. Hancox, James M. Raitt, James Smith, Iain M. Crombie, Nicholas Doughty, Heidi Perkins, Gavin D. Midwinter, Mark J. RESCUER Collaborators
Naumann, David N.
Hancox, James M.
Raitt, James
Smith, Iain M.
Crombie, Nicholas
Doughty, Heidi
Perkins, Gavin D.
Midwinter, Mark J.
RESCUER Collaborators
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Abstract
Objectives We investigated how often intravenous fluids
have been delivered during physician-led prehospital
treatment of patients with hypotensive trauma in the UK
and which fluids were given. These data were used to
estimate the potential national requirement for prehospital
blood products (PHBP) if evidence from ongoing trials were
to report clinical superiority.
Setting The Regional Exploration of Standard Care
during Evacuation Resuscitation (RESCUER) retrospective
observational study was a collaboration between 11 UK
air ambulance services. Each was invited to provide up to
5 years of data and total number of taskings during the
same period.
Participants Patients with hypotensive trauma (systolic
blood pressure <90mm Hg or absent radial pulse)
attended by a doctor.
Primary and secondary outcome measures The
primary outcome was the number of patients with
hypotensive trauma given prehospital fluids. Secondary
outcomes were types and volumes of fluids. These data
were combined with published data to estimate potential
national eligibility for PHBP.
Results Of 29037 taskings, 729 (2.5%) were for patients
with hypotensive trauma attended by a physician. Half
were aged 21–50 years; 73.4% were male. A total of 537
out of 729 (73.7%) were given fluids. Five hundred and
ten patients were given a single type of fluid; 27 received
>1type. The most common fluid was 0.9% saline, given
to 486/537 (90.5%) of patients who received fluids, at
a median volume of 750 (IQR 300–1500)mL. Three per
cent of patients received PHBP. Estimated projections for
patients eligible for PHBP at these 11 services and in the
whole UK were 313 and 794 patients per year, respectively.
Conclusions One in 40 air ambulance taskings were
manned by physicians to retrievepatients with hypotensive
trauma. The most common fluid delivered was 0.9%
saline. If evidence justifies universal provision of PHBP,
approximately 800 patients/year would be eligible in the
UK, based on our data combined with others published.
Prospective investigations are required to confirm or adjust
these estimations.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786144/pdf/bmjopen-2017-019627.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2017-019627