Observational studyShock (Augusta, Ga.)2015
Prehospital Resuscitation of Traumatic Hemorrhagic Shock with Hypertonic Solutions Worsens Hypocoagulation and Hyperfibrinolysis.
Observational study in Shock (Augusta, Ga.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Hypertonic Modulation of Inflammation Following Injury
Evaluation of Coagulation Activation in Patients With Intracranial Hypertension After Treatment With Mannitol or Hypertonic Saline Solution.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Prehospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries - A systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Pooled it
- Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2018Pooled it
- ALM Resuscitation Without Transfusion Improves Platelet Function and Survival After Liver Injury and Uncontrolled Hemorrhage.Medicina (Kaunas, Lithuania) · 2026Article
- Factors associated with a positive shock index in the prehospital setting after major trauma.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Disentangling the phenotypic patterns of hypertension and chronic hypotension.Journal of biomedical informatics · 2024Article
- Negative Factors Influencing Multiple-Trauma Patients.Clinics and practice · 2024Article
- A nomogram for predicting hemorrhagic shock in pediatric patients with multiple trauma.Scientific reports · 2024Article
- Prehospital balanced resuscitation may mitigate hypofibrinogenemia in traumatic hemorrhagic shock.Trauma surgery & acute care open · 2024Article
- Clinical Research in Prehospital Care: Current and Future Challenges.Clinics and practice · 2023Review
- Correlation between Coagulation Fibrinolysis Function and Outcomes during Hospitalization in Patients with Severe Traumatic Hemorrhagic Shock.Emergency medicine international · 2022Article
- Risk Factors and Neurologic Outcomes in Patients with Traumatic Brain Injury and Coagulopathy Within 72 h After Surgery.Neuropsychiatric disease and treatment · 2021Article
- A Machine Learning Approach for the Prediction of Traumatic Brain Injury Induced Coagulopathy.Frontiers in medicine · 2021Article
- Prehospital Damage Control: The Management of Volume, Temperature… and Bleeding!Colombia medica (Cali, Colombia) · 2020Review
- Examining the Effect of Hypertonic Saline Administered for Reduction of Intracranial Hypertension on Coagulation.Journal of the American College of Surgeons · 2020Article
- Resuscitation with centhaquin and 6% hydroxyethyl starch 130/0.4 improves survival in a swine model of hemorrhagic shock: a randomized experimental study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2019Article
- The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition.Critical care (London, England) · 2019Article
- Nonoperative Management of Blunt Splenic Trauma in Patients with Traumatic Brain Injury: Feasibility and Outcomes.World journal of surgery · 2018Article
- Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery.Perioperative medicine (London, England) · 2018Article
- Rotational thromboelastometry significantly optimizes transfusion practices for damage control resuscitation in combat casualties.The journal of trauma and acute care surgery · 2017Article
- Optimal Fluid Therapy for Traumatic Hemorrhagic Shock.Critical care clinics · 2017Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 4 institutions in 4 countries.
Funding
Abstract
Impaired hemostasis frequently occurs after traumatic shock and resuscitation. The prehospital fluid administered can exacerbate subsequent bleeding and coagulopathy. Hypertonic solutions are recommended as first-line treatment of traumatic shock; however, their effects on coagulation are unclear. This study explores the impact of resuscitation with various hypertonic solutions on early coagulopathy after trauma. We conducted a prospective observational subgroup analysis of large clinical trial on out-of-hospital single-bolus (250 mL) hypertonic fluid resuscitation of hemorrhagic shock trauma patients (systolic blood pressure, ≤70 mmHg). Patients received 7.5% NaCl (HS), 7.5% NaCl/6% Dextran 70 (HSD), or 0.9% NaCl (normal saline [NS]) in the prehospital setting. Thirty-four patients were included: 9 HS, 8 HSD, 17 NS. Treatment with HS/HSD led to higher admission systolic blood pressure, sodium, chloride, and osmolarity, whereas lactate, base deficit, fluid requirement, and hemoglobin levels were similar in all groups. The HSD-resuscitated patients had higher admission international normalized ratio values and more hypocoagulable patients, 62% (vs. 55% HS, 47% NS; P < 0.05). Prothrombotic tissue factor was elevated in shock treated with NS but depressed in both HS and HSD groups. Fibrinolytic tissue plasminogen activator and anti-fibrinolytic plasminogen activator inhibitor type 1 were increased by shock but not thrombin-activatable fibrinolysis inhibitor. The HSD patients had the worst imbalance between procoagulation/anticoagulation and profibrinolysis/antifibrinolysis, resulting in more hypocoagulability and hyperfibrinolysis. We concluded that resuscitation with hypertonic solutions, particularly HSD, worsens hypocoagulability and hyperfibrinolysis after hemorrhagic shock in trauma through imbalances in both procoagulants and anticoagulants and both profibrinolytic and antifibrinolytic activities.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.