Strategies for Trauma Resuscitation from Deep Shock.
A group of patients arriving in the trauma center 15 minutes from time of injury with recent loss of
vital signs were resuscitated. Some of these patients appeared clinically dead. Rapid airway control
and IV access with high infusion rates of heated saline solutions were performed. Initial placement
of a short 8.5 F cannula via the femoral vein was the approach of choice. This was a deviation from
the ATLS protocol for patients in Class III/IV hypovolemia. Rapid infusion was defined as a rate > 5
L/hr. An attempt was made to obtain improved vital signs in the Emergency Department before
transfer to the operating room; 95% of the trauma was penetrating. Time to the operating room from
the emergency room decreased from 30 minutes to 15 minutes with the Level I infusion system.
Four patients were discharged who had initially been without signs of life. Dr. Buchman notes that
circulatory shock with a systolic pressure less than 70 mm Hg has a 62% mortality within 30
minutes. A core temperature of less than 33° C was associated with a tenfold higher death rate. The
Revised Trauma Score/Injury Severity Score demonstrated improved survival rates in this
"population of unlikely one-hour survivors."
Surg Gynecol Obstet 172: 8, 1991.