Pre-hospital use of intravenous in-line fluid warmers to reduce morbidity and mortality for major trauma patients: A review of the current literature

Abstract

Introduction In-line fluid warmers are an established treatment for delivering warmed intravenous fluid in the hospital setting. Recently their potential application within the pre-hospital setting has been highlighted to potentially reduce mortality and morbidity. Currently ambulance paramedics only administer warmed fluid to patients assessed as hypothermic, and this fluid is subject to further cooling on exposure to ambient environmental conditions. This review examined the peer-reviewed literature to determine the available evidence for in-line fluid warmer effectiveness and potential inclusion in pre-hospital emergency care. Methods A review of the electronic literature, including the MEDLINE and EBSCOhost databases was conducted using the terms ‘intravenous fluid warmers’, ‘hypothermia’, ‘trauma’, ‘fluid’, ‘coagulopathy’, ‘acidosis’, ‘hypothermia and trauma patients’, ‘accidental hypothermia’, ‘lethal triad’ and ‘trauma care’. Articles were included if they represented a study of in-line fluid warmers within the surgical, general hospital or pre-hospital emergency care settings. Articles not available in English or as full text were excluded. Results The review identified 23 relevant articles for analysis. Of note, up to 40% of trauma patients with signs of hypoperfusion were reported to arrive at hospital in a hypothermic state post-incident. Hypothermia plays a significant role in contributing to the ‘triad of death’ - a condition that results in poor patient outcomes and high mortality rates. Conclusion This review identified that current pre-hospital practice does not prescribe warmed fluid to the normothermic trauma patient. The review also identified that there is a need for in-line fluid warmers in ambulance practice to prevent or limit hypothermia and reduce patient morbidity and mortality associated with trauma.