Prospective, Randomized Trial of Survivor Values of Cardiac Index, Oxygen Delivery, and Oxygen Consumption as Resuscitation Endpoints in Severe Trauma

Abstract

The objective was to test prospectively supranormal values of cardiac index (CI), oxygen delivery index (Dosub 2 I), and oxygen consumption index (Vosub 2 I) as resuscitation goals to improve outcome in severely traumatized patients. We included patients greater than or equal to16 years of age who had either (1) an estimated blood loss greater than or equal to2000 mL or (2) a pelvic fracture and/or two or more major long bone fractures with greater than or equal to four units of packed red cells given within six hours of admission. The protocol resuscitation goals were CI greater than or equal to 4.5 L/min/msup 2 , Dosub 2 I greater than or equal to 670 mL/min/msup 2 , and Vosub 2 I greater than or equal to 166 mL/min/msup 2 within 24 hours of admission. The control resuscitation goals were normal vital signs, urine output, and central venous pressure. The 50 protocol patients had a significantly lower mortality (9 of 50, 18% vs. 24 of 65, 37%) and fewer organ failures per patient (0.74 +/- 0.28 vs. 1.62 +/- 0.45) than did the 75 control patients. We conclude that increased CI, Dosub 2 I, and Vosub 2 I seen in survivors of severe trauma are primary compensations that have survival value; augmentation of these compensations compared to conventional therapy decreases mortality.