Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the resuscitation outcomes consortium

Samuel A. Tisherman, Robert H. Schmicker, Karen Brasel, Eileen M. Bulger, Jeffrey D. Kerby, Joseph P. Minei, Judy L. Powell, Donald A. Reiff, Sandro B. Rizoli, Martin Schreiber

    Research output: Contribution to journalArticle

    61 Citations (Scopus)

    Abstract

    Objective: To identify causes and timing of mortality in trauma patients to determine targets for future studies. Background: In trials conducted by the Resuscitation Outcomes Consortium in patients with traumatic hypovolemic shock (shock) or traumatic brain injury (TBI), hypertonic saline failed to improve survival. Selecting appropriate candidates is challenging. Methods: Retrospective review of patients enrolled in multicenter, randomized trials performed from 2006 to 2009. Inclusion criteria were as follows: injured patients, age 15 years or more with hypovolemic shock [systolic blood pressure (SBP) ≤ 70 mm Hg or SBP 71-90 mm Hg with heart rate ≥ 108) or severe TBI [Glasgow Coma Score (GCS) ≤ 8]. Initial fluid administered was 250 mL of either 7.5% saline with 6% dextran 70, 7.5% saline or 0.9% saline. Results: A total of 2061 subjects were enrolled (809 shock, 1252 TBI) and 571 (27.7%) died. Survivors were younger than nonsurvivors [30 (interquartile range 23) vs 42 (34)] and had a higher GCS, though similar hemodynamics. Most deaths occurred despite ongoing resuscitation. Forty-six percent of deaths in the TBI cohort were within 24 hours, compared with 82% in the shock cohort and 72% in the cohort with both shock and TBI. Median time to death was 29 hours in the TBI cohort, 2 hours in the shock cohort, and 4 hours in patients with both. Sepsis and multiple organ dysfunction accounted for 2% of deaths. Conclusions: Most deaths from trauma with shock or TBI occur within 24 hours from hypovolemic shock or TBI. Novel resuscitation strategies should focus on early deaths, though prevention may have a greater impact.

    Original languageEnglish (US)
    Pages (from-to)586-590
    Number of pages5
    JournalAnnals of Surgery
    Volume261
    Issue number3
    DOIs
    StatePublished - 2015

    Fingerprint

    Resuscitation
    Shock
    Blood Pressure
    Coma
    Traumatic Shock
    Traumatic Brain Injury
    Wounds and Injuries
    Dextrans
    Multicenter Studies
    Survivors
    Sepsis
    Heart Rate
    Hemodynamics
    Survival
    Mortality

    Keywords

    • Clinical trial
    • Hemorrhagic shock
    • Mortality
    • Trauma
    • Traumatic brain injury

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the resuscitation outcomes consortium. / Tisherman, Samuel A.; Schmicker, Robert H.; Brasel, Karen; Bulger, Eileen M.; Kerby, Jeffrey D.; Minei, Joseph P.; Powell, Judy L.; Reiff, Donald A.; Rizoli, Sandro B.; Schreiber, Martin.

    In: Annals of Surgery, Vol. 261, No. 3, 2015, p. 586-590.

    Research output: Contribution to journalArticle

    Tisherman, Samuel A. ; Schmicker, Robert H. ; Brasel, Karen ; Bulger, Eileen M. ; Kerby, Jeffrey D. ; Minei, Joseph P. ; Powell, Judy L. ; Reiff, Donald A. ; Rizoli, Sandro B. ; Schreiber, Martin. / Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the resuscitation outcomes consortium. In: Annals of Surgery. 2015 ; Vol. 261, No. 3. pp. 586-590.
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    abstract = "Objective: To identify causes and timing of mortality in trauma patients to determine targets for future studies. Background: In trials conducted by the Resuscitation Outcomes Consortium in patients with traumatic hypovolemic shock (shock) or traumatic brain injury (TBI), hypertonic saline failed to improve survival. Selecting appropriate candidates is challenging. Methods: Retrospective review of patients enrolled in multicenter, randomized trials performed from 2006 to 2009. Inclusion criteria were as follows: injured patients, age 15 years or more with hypovolemic shock [systolic blood pressure (SBP) ≤ 70 mm Hg or SBP 71-90 mm Hg with heart rate ≥ 108) or severe TBI [Glasgow Coma Score (GCS) ≤ 8]. Initial fluid administered was 250 mL of either 7.5{\%} saline with 6{\%} dextran 70, 7.5{\%} saline or 0.9{\%} saline. Results: A total of 2061 subjects were enrolled (809 shock, 1252 TBI) and 571 (27.7{\%}) died. Survivors were younger than nonsurvivors [30 (interquartile range 23) vs 42 (34)] and had a higher GCS, though similar hemodynamics. Most deaths occurred despite ongoing resuscitation. Forty-six percent of deaths in the TBI cohort were within 24 hours, compared with 82{\%} in the shock cohort and 72{\%} in the cohort with both shock and TBI. Median time to death was 29 hours in the TBI cohort, 2 hours in the shock cohort, and 4 hours in patients with both. Sepsis and multiple organ dysfunction accounted for 2{\%} of deaths. Conclusions: Most deaths from trauma with shock or TBI occur within 24 hours from hypovolemic shock or TBI. Novel resuscitation strategies should focus on early deaths, though prevention may have a greater impact.",
    keywords = "Clinical trial, Hemorrhagic shock, Mortality, Trauma, Traumatic brain injury",
    author = "Tisherman, {Samuel A.} and Schmicker, {Robert H.} and Karen Brasel and Bulger, {Eileen M.} and Kerby, {Jeffrey D.} and Minei, {Joseph P.} and Powell, {Judy L.} and Reiff, {Donald A.} and Rizoli, {Sandro B.} and Martin Schreiber",
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    T1 - Detailed description of all deaths in both the shock and traumatic brain injury hypertonic saline trials of the resuscitation outcomes consortium

    AU - Tisherman, Samuel A.

    AU - Schmicker, Robert H.

    AU - Brasel, Karen

    AU - Bulger, Eileen M.

    AU - Kerby, Jeffrey D.

    AU - Minei, Joseph P.

    AU - Powell, Judy L.

    AU - Reiff, Donald A.

    AU - Rizoli, Sandro B.

    AU - Schreiber, Martin

    PY - 2015

    Y1 - 2015

    N2 - Objective: To identify causes and timing of mortality in trauma patients to determine targets for future studies. Background: In trials conducted by the Resuscitation Outcomes Consortium in patients with traumatic hypovolemic shock (shock) or traumatic brain injury (TBI), hypertonic saline failed to improve survival. Selecting appropriate candidates is challenging. Methods: Retrospective review of patients enrolled in multicenter, randomized trials performed from 2006 to 2009. Inclusion criteria were as follows: injured patients, age 15 years or more with hypovolemic shock [systolic blood pressure (SBP) ≤ 70 mm Hg or SBP 71-90 mm Hg with heart rate ≥ 108) or severe TBI [Glasgow Coma Score (GCS) ≤ 8]. Initial fluid administered was 250 mL of either 7.5% saline with 6% dextran 70, 7.5% saline or 0.9% saline. Results: A total of 2061 subjects were enrolled (809 shock, 1252 TBI) and 571 (27.7%) died. Survivors were younger than nonsurvivors [30 (interquartile range 23) vs 42 (34)] and had a higher GCS, though similar hemodynamics. Most deaths occurred despite ongoing resuscitation. Forty-six percent of deaths in the TBI cohort were within 24 hours, compared with 82% in the shock cohort and 72% in the cohort with both shock and TBI. Median time to death was 29 hours in the TBI cohort, 2 hours in the shock cohort, and 4 hours in patients with both. Sepsis and multiple organ dysfunction accounted for 2% of deaths. Conclusions: Most deaths from trauma with shock or TBI occur within 24 hours from hypovolemic shock or TBI. Novel resuscitation strategies should focus on early deaths, though prevention may have a greater impact.

    AB - Objective: To identify causes and timing of mortality in trauma patients to determine targets for future studies. Background: In trials conducted by the Resuscitation Outcomes Consortium in patients with traumatic hypovolemic shock (shock) or traumatic brain injury (TBI), hypertonic saline failed to improve survival. Selecting appropriate candidates is challenging. Methods: Retrospective review of patients enrolled in multicenter, randomized trials performed from 2006 to 2009. Inclusion criteria were as follows: injured patients, age 15 years or more with hypovolemic shock [systolic blood pressure (SBP) ≤ 70 mm Hg or SBP 71-90 mm Hg with heart rate ≥ 108) or severe TBI [Glasgow Coma Score (GCS) ≤ 8]. Initial fluid administered was 250 mL of either 7.5% saline with 6% dextran 70, 7.5% saline or 0.9% saline. Results: A total of 2061 subjects were enrolled (809 shock, 1252 TBI) and 571 (27.7%) died. Survivors were younger than nonsurvivors [30 (interquartile range 23) vs 42 (34)] and had a higher GCS, though similar hemodynamics. Most deaths occurred despite ongoing resuscitation. Forty-six percent of deaths in the TBI cohort were within 24 hours, compared with 82% in the shock cohort and 72% in the cohort with both shock and TBI. Median time to death was 29 hours in the TBI cohort, 2 hours in the shock cohort, and 4 hours in patients with both. Sepsis and multiple organ dysfunction accounted for 2% of deaths. Conclusions: Most deaths from trauma with shock or TBI occur within 24 hours from hypovolemic shock or TBI. Novel resuscitation strategies should focus on early deaths, though prevention may have a greater impact.

    KW - Clinical trial

    KW - Hemorrhagic shock

    KW - Mortality

    KW - Trauma

    KW - Traumatic brain injury

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