First10 EM - By Justin Morgenstern - April 25, 2022
Trauma patients aren’t bleeding salty water, so why would you give them intravenous salty water? It doesn’t make any sense. Obviously, if they require fluid resuscitation, it should be with the fluid they are losing. So when we compare blood products to normal saline in an RCT (the RePHILL study), we are bound to see a massive benefit, right? RIGHT?!
The paper: The RePHILL trial. Crombie N, Doughty HA, Bishop JRB, Desai A, Dixon EF, Hancox JM, Herbert MJ, Leech C, Lewis SJ, Nash MR, Naumann DN, Slinn G, Smith H, Smith IM, Wale RK, Wilson A, Ives N, Perkins GD; RePHILL collaborative group. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Haematol. 2022 Apr;9(4):e250-e261. doi: 10.1016/S2352-3026(22)00040-0. PMID: 35271808 ISRCTN62326938
Bottom line
Despite some very strong physiologic reasons that blood should be preferred in trauma patients, this RCT failed to demonstrate any benefit over normal saline. I still would never preferentially use saline if I thought a patient needed blood, but this trial should reassure you if you need to give a small crystalloid bolus while waiting for blood to arrive.