AUTHORS
Carmen Martí Marqués
José Vte. Carmona-Simarro
KEY WORDS
Haemorrhagic shock, Haemoderivatives, Fluid therapy, Red cell concentrate, Plasma, Platelets, Crystalloids, Colloids, Pre-hospital treatment, Emergency medical services.
ABSTRACT
Introduction. Haemorrhagic shock is an emergency that is associated with increased mortality, especially in a pre-hospital setting, caused by road traffic accidents resulting in severe polytrauma. It is a time-dependent situation in the sense that if blood loss is treated quickly the victim’s chances of survival increase. Pre-hospital emergency medical services (EMS) do not usually carry blood derivatives in their equipment, especially in urban settings as the time to hospital is usually short, and fluids are used to maintain blood pressure. However, there is evidence of significant side effects from the overuse of certain fluids.
Goal. To analyse the scientific evidence in relation to the treatment of haemorrhagic shock in pre-hospital emergency services, assessing the efficacy of these treatments and the associations made between them.
Method. A Systematised Review of Randomised Clinical Trials (RCTs) published in the last 5 years (2018-2022) was conducted. The PRISMA® system was used to structure each of the different sections in the review. The JADAD scale for RCTs was applied to each of the articles in order to classify them according to their level of scientific quality.
Results. Eleven papers were selected that met the selection criteria and the goals. Five of them were multicentre papers. A flow chart of the search and a table of results of the main variables of interest were drawn up. The JADAD scale scored an average of 5 points.
Discussion. The review reaffirmed the need to show health actions with the highest level of recommendation in order to improve patient prognosis, increase survival and decrease mortality. The treatments used, with statistical significance in the RCTs in this selection were, in the case group, plasma, either fresh or lyophilised. In the control group, crystalloids such as 0.9% sodium chloride, lactated Ringer’s, red blood cell concentrate and vasopressin were used.