Pr. Hambly et Rp. Dutton, EXCESS MORTALITY ASSOCIATED WITH THE USE OF A RAPID INFUSION SYSTEM AT A LEVEL-1 TRAUMA CENTER, Resuscitation, 31(2), 1996, pp. 127-133
The Rapid Infusion System (RIS(TM)) is a device which can deliver warm
fluid and blood products rapidly and at precise rates. It has been in
use since 1990 for the management of victims of major trauma at the R
Adams Cowley Shock Trauma Center (STC) in Baltimore. Although the RIS
is unquestionably a convenience to the anesthesiologist, no study to
date has addressed its effect on patient outcome. We have therefore un
dertaken a retrospective review of all uses of the RIS on trauma patie
nts during the years in which it has been available at the Shock Traum
a Center, comparing actual patient mortality both to expected mortalit
y derived from the STC Trauma Registry, and to matched historical cont
rols who did not receive fluids via the RIS. A total of 527 patients w
ere included in the study. The mean volume infused via the RIS was 972
4 ml, and the total volumes ranged from 24-117 585 ml. Overall surviva
l was significantly less than expected (52.9% vs. 61.8%, P < 0.001). S
urvival in penetrating trauma was similar to expected, but in blunt tr
auma it was considerably less (48.8% vs. 63.0%, P < 0.001). Patients w
hose probability of survival was between 0.1% and 0.9% also survived s
ignificantly less frequently than expected (44.3% vs. 57%, n = 105, P
< 0.008). In those patients who received less than 6000 ml via the RIS
, the actual and expected survival rates were almost identical. In tho
se receiving more than 6000 ml (180 patients), the difference between
actual and expected survival was striking (37.2% vs. 57.2%, P < 0.0001
). As compared to matched control patients injured to the same extent
during the same time period, patients who received fluids via the RIS
had a 4.8 times greater chance of dying (95% confidence interval 2.4-7
.1). These data call into question current protocols for rapid volume
infusion in trauma management and point to the need for further prospe
ctive trials.