Pre-hospital use of intravenous in-line fluid warmers to reduce morbidity and mortality for major trauma patients: A review of the current literature.

Nicholas Collins, Stuart Daly, Patricia Johnson, Gavin Smith

Abstract


Introduction

In-line fluid warmers are an established treatment for delivering warmed intravenous (IV) fluid in the hospital setting. Recently their potential application within the pre-hospital setting has been highlighted to potentially reduce mortality and morbidity. Currently ambulance paramedics only administer warmed fluid to patients assessed as hypothermic, and this fluid is subject to further cooling on exposure to ambient environmental conditions. This review examined the peer-reviewed literature to determine the available evidence for in-line fluid warmer effectiveness and potential inclusion in pre-hospital emergency care.

Methods

A review of the electronic literature, including the Medline and Ebscohost databases was conducted using the terms “intravenous fluid warmers” “hypothermia”, “ trauma”, “ fluid”, “coagulopathy”, “ acidosis”, “hypothermia and trauma patients”, “accidental hypothermia”, “lethal triad” and “trauma care”. Articles were included if they represented a study of in-line fluid warmers within the surgical, general hospital or pre-hospital emergency care settings. Articles not available in English or as full text were excluded.

Results

The review identified 23 relevant articles for analysis. Of note, up to 40% of trauma patients with signs of hypoperfusion were reported to arrive at hospital in a hypothermic state post-incident. Hypothermia plays a significant role in contributing to the ‘triad of death’- a condition that results in poor patient outcomes and high mortality rates.

Conclusion

This review identified that current pre-hospital practice does not prescribe warmed fluid to the normothermic trauma patient. The review also identified that there is a need for in-line fluid warmers in ambulance practice to prevent or limit hypothermia and reduce patient morbidity and mortality associated with trauma.


Keywords


fluid warmer; pre-hospital; trauma

Full Text:

PDF

References


Kotagal M, Agarwal-Harding KJ, Mock C, Quanash R, Arreola-Risa C, Meara JG. Health and Economic Benefits of Improved Injury Prevention and Trauma Care Worldwide. PLoS ONE 2014;9(3):1–7.

Ireland S, Endacott R, Cameron P, Fitzgerald M, Paul E. The incidence and significance of accidental hypothermia in major trauma – a prospective observational study. Resuscitation 2011;82:300–6.

Sweeney J. Mass transfusion to combat trauma’s lethal triad. J Emerg Nurs 2013;39(1):37–9.

Wafaisade A, Wutzler S, Lefering R, et al. Drivers of acute coagulopathy after severe trauma: a multivariate analysis of 1987 patients. Emerg Med J 2010;27:934–9.

Moffatt SE. Hypothermia in Trauma. ibid. 2012;30.

Katrancha ED, Gonzalez LS. Trauma-Induced Coagulopathy. Crit Care Nurse 2014;34(4):54–63.

Moore K. Hypothermia in Trauma. J Trauma Nurs 2008;15(2):62–4.

Pearson J, Round J, Ingram M. Management of shock in trauma. Anaesthesia and Intensive Care Medicine 2011;12(9):387–9.

Mommsen P, Andruszkow H, Frömke C, et al. Effects of accidental hypothermia on posttraumatic complications and outcome in multiple trauma patients. Injury 2013;44:86–90.

Søreide K. Clinical and translational aspects of hypothermia in major trauma patients: from pathophysiology to prevention, prognosis and potential preservation. ibid. 2014;45:647–54.

Singer AJ, Taira BR, Thode HC, et al. The association between hypothermia, prehospital cooling, and mortality in burn victims. Acad Emerg Med 2010;17(4):456–9.

Wheeler R, von Recklinghausen FM, Brozen R. Blood administration in helicopter emergency medical services patients associated with hypothermia. Air Med J 2013;32(1):47–51.

Lapostolle F, Sebbah JL, Couvreur J, et al. Risk factors for onset of hypothermia in trauma victims: the HypoTraum study. Crit Care Nurse 2012;16:142.

Avellanas ML, Ricart A, Botella J, Mengelle F, Soteras I, Veres T, et al. Management of severe accidental hypothermia. Medicina Intensiva 2012;36(3):200–12.

Sundberg J, Estrada C, Jenkins C, Ray J, Abramo T. Hypothermia is associated with poor outcomes in pediatric trauma patients. Am J Emerg Med 2011;29:1019–22.

Langhelle A, Lockey D, Harris T, Davies G. Body temperature of trauma patients on admission to hospital: a comparison of anaesthetised and non-anaesthetised patients. Emerg Med J 2012;29:239–42.

Andrzejowski JC, Turnbull D, Nandakumar A, Gowthaman S, Eapen G. A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures. Anaesthesia and Intensive Care Medicine 2010;65:942–5.

Bruells CS, Bruells AC, Rossaint R, Stoppe C, Schaelte G, Zoremba N. A laboratory comparison of the performance of the buddy lite™ and enFlow™ fluid warmers. Anaesthesia and Intensive Care Medicine 2013;68(11):1161–4.

Aitken LM, Hendrikz JK, Dulhunty JM, Rudd MJ. Hypothermia and associated outcomes in seriously injured trauma patients in a predominantly sub-tropical climate. Resuscitation 2009;80:217–23.

Karlsen AM, Thomassen Ø, Vikenes BH, Brattebø G. Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services. Scand J Trauma Resusc Emerg Med 2013;21:63.

Monzón CGC, Arana CAC, Valz HAM, Rodríguez FA, Mejía JJB, Gómez JAA. Temperature management during the perioperative period and frequency of inadvertent hypothermia in a general hospital. Colombian Journal of Anaesthesiology 2013;41(2):97–103.

Lundgren P, Henriksson O, Naredi P, Björnstig U. The effect of active warming in prehospital trauma care during road and air ambulance transportation – a clinical randomized trial. Scand J Trauma Resusc Emerg Med 2011;19:59.

Piek R, Stein C. Three insulation methods to minimize intravenous fluid administration set heat loss. Prehosp Emerg Care 2013;17(1):68–72.

Ambulance Victoria. 2012 Clincal Practice Guidelines for Ambulance and MICA Paramedics: Ambulance Victoria; 2012.




DOI: http://dx.doi.org/10.33151/ajp.12.2.139

Refbacks

  • There are currently no refbacks.




The Official Journal of Paramedics Australasia © 2019                           ISSN: 2202-7270

 

Crossref Member Badge