Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

Background: During resuscitation trauma patients receive various intravenous fluids, which can exacerbate coagulopathy and haemorrhage further. This led to the introduction of the damage control resuscitation, which advocates minimal intravenous fluids use. However, some fluid may be required in uncontrolled haemorrhage or when blood products are not immediately available. Furthermore, questions regarding the type and volume of the administered fluids remain still unanswered. Methods: Review of literature. Results: Crystalloids such as 0.9% Isotonic Saline and Lactate Ringers can cause either a hypercoagulable (lower dilutions) or hypocoagulable (higher dilutions) derangements. Hypertonic Saline (7.5%) leads to more pronounced coagulation abnormalities when compared with 0.9% Isotonic Saline. The effects of the 7.5% Hypertonic Saline combined with 6 % Dextran 70 are controversial. Some authors reported significant clotting abnormalities, but others found an improvement in the haemodynamic parameters. The evidence on human albumin solution use in trauma is very limited and suggests a procoagulant effect at lower dilutions. Gelofusine even with smaller volumes leads to pronounced coagulation abnormalities. All Dextrans (40 and 70) cause significant hypocoagulability at lower dilutions. Similarly lower molecular starches demonstrate a definite hypocoagulable effect. Conclusions: A literature review has also indicated that none of the studies demonstrated survival or outcome benefit associated with a particular type and volume of administered intravenous fluids. The results are controversial and further research is needed to clarify this issue.