Fluid Resuscitation in Haemorrhagic Shock

Abstract

Apart from achieving early haemostasis, successful management of haemorrhagic shock relies on appropriate resucitation without worsening the bleeding itself. This later strategy is now popularly known as “Damage Control Resuscitation”. Cornerstones of damage control resuscitation are restricted use of crystalloids, haemostatic resuscitation and avoidance (and early correction) of coagulopathy, hypothermia and acidosis. Agrressive crystalloid infusion can potentially dislodge the incessant clot potentiating further bleeding, worsen hypothermia/acidosis and produce dilutional coagulopathy. Strategy of permissive hypotension, controlled resuscitation or delayed resuscitation can potentially restrict total crystalloid volume, provided all efforts are made to restore early haemostasis. In majority of patients with haemorrhagic shock, warm balanced isotonic crystalloids should be used for resuscitation purposes, excepting in patients with suspected traumatic brain injury. In later cases, 0.9% Saline or Sterofundin should be considered. Colloids should be avoided in resuscitation of haemorrhagic shock. Early recognition of the need for and initiation of massive transfusion protcol is important for achieving haemostatic resuscitation. Massive transfusion protcol should maintain FFP:Platelet: PRBC ratio of 1:1:1. All other measures to limit bleeding like tranexamic acid or recombinant factor VII or reversal of anti-coagulation should be used appropriately.