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Table 4 Fluid resuscitation and adjuncts in haemorrhagic shock. AKI: acute kidney injury; CNS: central nervous system; HES: hydroxyethyl starch solution; ICU: intensive care unit; MA: metabolic acidosis; PRBCs: packed red blood cells; TBI: traumatic brain injury

From: Multiple trauma management in mountain environments - a scoping review

Agent Advantages Disadvantages Notes
0.9% Normal Saline (‘unbalanced’)
Readily available, familiar; compatible with most medications and blood products Not ‘physiologic’ (high chloride load); excess administration leads to AKI and MA (2C) Bolus to effect after bleeding controlled. (1A)
Ringer’s lactate/ acetate (‘balanced’); Plasmalyte Readily available; ‘physiologic’ Slightly hypotonic; excess administration worsens TBI (1C) May reduce incidence of AKI and mortality in ICU. Bolus with control of bleed (1A)
Hypertonic saline solution Low weight and volume (easier to transport); thermal stability; safe May interfere with coagulation in patients with severe TBI NaCl concentration > 0.9%; may expand volume, no long term survival benefit or improved CNS outcome vs. NaCl 0.9%
Albumin, hydroxyethyl starch (HES), Dextran
Used as volume expander Expensive; no proven mortality benefit. HES may increase harm in some subgroups. Prehospital data still rare. HES may impair coagulation
PACKED RED BLOOD CELLS / PLASMA / WHOLE BLOOD May improve survival or physiology, for Hb < 7 g/dL; lyophilised plasma is used in damage control Inconvenient in out-of-hospital environment; ARDS/ transfusion reactions Used by few centres; PRBCs:plasma: platelets 1:1:1 or 2:1:1 (1B), or fibrinogen 0.5 g per unit PRBCs (1C) in hospital
VASOPRESSORS Use after adequate volume replacement (1C), Push-dose pressors simple; cardiac dysfunction: epinephrine Does not treat cause; uncertain long-term benefit; dosing errors,; uncertain benefit (haemorrhage) Constricts capacitance vessels; used in airway management / TBI with hypotension