Trauma and associated major blood losses in Germany represent the lead
ing cause of mortality in patients up to 45 years of age. The endpoint
s of prehospital fluid resuscitation in traumatic-hemorrhagic shock ar
e the restitution of intravascular volume und cardiac preload, in orde
r to increase cardiac output and thus provide adequate oxygen delivery
to the tissues. The key therapeutic factor to prevent the development
of multiple organ failure complicating trauma and shock, however, is
the normalization not only of macrohemodynamics (systemic blood pressu
re, cardiac output), but the restitution of the disturbed microvascula
r perfusion. In case of major blood loss and exsanguination this can n
ot be achieved by crystalloids and synthetic colloids used in conventi
onal volume therapy. A new concept consists of i.v. bolus in fusion of
a small volume (4 ml/kg body weight) of a hyperosmolar (7,2-7,5%) NaC
l/colloid solution, which is termed ''Small-volume Resuscitation''. Re
cently presented data from a cohort analysis of 8 preclinical studies
show an increase in survival rate by about 5% when compared to standar
d of care. In addition, artificial oxygen carrying solutions are curre
ntly investigated, by which - through an increase of O-2-blood content
- oxygen delivery to the tissues might be augmented.