(i) Being ≥16 years (ii) GSW/stab wound to torso (iii) SBP ≤ 90 mmHg
(i) Being pregnant (ii) Revised Trauma Score = 0 (iii) Fatal GSW to head (iv) Minor injuries not requiring surgery
Immediate: rapid infusion of Ringer’s solution in-route to hospital Delayed: no fluids in-route to hospital
(i) Increased survival to hospital discharge in delayed (70%) versus immediate (62%) group (ii) Shorter hospital LOS in delayed (11 ± 24 days) versus immediate (14 ± 24 days) groups (iii) No differences in RDS, sepsis, ARF, coagulopathy, wound infection, or pneumonia
(i) Adult trauma patients treated by randomized paramedic crew with at least one of the following: (a) Hospital LOS ≥ 3 days (b) Being admitted to ICU (c) Patients who died after paramedics arrived (d) Being transferred to another hospital (e) Death within 6 months of injury and cause of death was trauma from accident
(i) Being pregnant (ii) Poisonings, hangings, drownings, asphyxiation (iii) Being transported to hospital by helicopter (iv) Being treated by nonrandomized paramedic or doctor (v) Being dead before paramedics arrived at scene (vi) Superficial skin injuries (vii) Any patient with burns (viii) Having the following at admission: isolated fractured neck of femur, single pubic rami fracture, simple facial injury, simple spinal sprain (ix) Patients in “major incidents” (x) Being <16 years (xi) Patients treated by EMT only (xii) Patients referred by GP
Protocol A: fluids started at the scene Protocol B: fluids withheld until hospital arrival
(i) No difference in mortality at 6 months for patients in Protocol A (10.4%) versus Protocol B (9.8%) (ii) No differences in the hospital or ICU LOS (iii) No differences in the proportion of patients with complications
(i) Blunt or penetrating trauma (ii) Being >15 years (iii) SBP ≤ 90 mmHg (iv) No evidence of severe head injury (v) GCS > 8
(i) Being pregnant (ii) Receiving > 250 mL of fluid before randomization (iii) Receiving CPR by EMS (iv) Drowning (v) Asphyxia due to hanging (vi) Burns on >20% of body (vii) Being incarcerated (viii) >4 hours between call to dispatch and intervention (ix) Ground level falls (x) Bilateral paralysis
Standard: initial 2 L bolus of fluid with additional fluid to maintain SBP of 110 mmHg Controlled: 250 mL bolus of fluid to maintain SBP of 70 mmHg
(i) No differences in 24-hour mortality (5.2% versus 14.7%) or in-hospital mortality (8.4% versus 16.5%) for the controlled versus standard resuscitation groups, respectively (ii) Blunt trauma subgroup with controlled resuscitation had decreased mortality (3.2% versus 17.7%) (iii) No differences in major surgical procedures, renal function, ICU-free days, or ventilator-free days
Exclusions added as the study progressed. Italicized outcomes are statistically significant, . ARF: acute renal failure; CPR: cardiopulmonary resuscitation; EMS: emergency medical service; EMT: emergency medical technician; GCS: Glasgow coma score; GP: general practitioner; GSW: gunshot wound; ICU: intensive care unit; LOS: length of stay; RDS: respiratory distress syndrome; SBP: systolic blood pressure.
