Fluid Replacement in Warfare Victims in Hemorrhagic Shock

Hemorrhagic shock is the leading cause of preventable death in warfare victims. Early resuscitation relies on prompt administration of suitable crystalloid and colloid solutions as well as whole blood and blood components. The purpose of this study was to present an effective guideline for use at emergency posts near the front lines to prevent the death of warfare victims in hemorrhagic shock.

In this short overview, our experience with fluid resuscitation in the management of hemorrhagic shock in wounded combatants during the Iraq-Iran war is presented.

Dry plasma, whole blood, and blood products to increase the plasma volume were used. Increasing intravascular volume targeting a systolic blood pressure of 90 mmHg was deemed optimal for maintaining perfusion of vital organs. Hypotensive resuscitation, damage control resuscitation via transfusion of whole blood, colloids, and limited volumes of crystalloids were effective in the management of shock.

Early resuscitation using whole blood primarily is recommended for the resuscitation of hypotension whenever possible. When blood products are not available colloids are preferred and are considered the next best option and are preferred over crystalloid solutions for the management of shock.