11 NZMJ 20 November 2020, Vol 133 No 1525 ISSN 1175-8716 © NZMA www.nzma.org.nz/journal An audit of fluid resuscitation practice in trauma patients with major haemorrhage at Christchurch Hospital Calan Jones, Bianca Wadham, Wayne Morriss, Andrew McCombie, Melissa Evans, Christopher Wakeman T he incidence of major trauma in New Zealand is approximately 48 per 100,000 population per year, with a fatality rate of 8.4%. The majority of these deaths are due to traumatic brain or spinal cord injury, but approximately 12.6% of fatalities are due to haemorrhage, a poten- tially preventable cause of traumatic death. Although deaths due to traumatic haemor- rhage in New Zealand have reduced during recent years, New Zealand is still lagging behind other countries where fatality rates in major trauma due to haemorrhage are closer to 3%. 1,2 Damage control resuscitation (DCR) is now considered a standard of care in the management of severe trauma. The aim of DCR is the prevention or minimisation of the lethal trauma triad of acidosis, coagulopathy and hypothermia. In major haemorrhage, DCR focuses on limitation of crystalloid fluid resuscitation and early use of blood products. 3 Despite recent literature supporting the use of whole blood products, protocolised blood component therapy is still used in New Zealand for patients requiring massive ABSTRACT AIMS: Damage control resuscitation with limited crystalloids and early use of blood products is now considered standard care in major trauma. The purpose of this study was to audit resuscitation practice in trauma patients where a massive transfusion protocol (MTP) had been activated, to determine whether crystalloid administration and adherence to the MTP had improved since an audit and education sessions in July 2017. METHODS: We conducted a retrospective study looking at trauma patients presenting to Christchurch Hospital who had a MTP activated form the 1 May 2016 to 1 March 2019. Patients were identified by cross- referencing the trauma call database with the electronic transfusion registry. RESULTS: Thirty-four patients were included in the audit. There was no significant difference in mean crystalloid administration before and aſter July 2017 (5.74 litres and 4.86 litres respectively). Patients presenting before July 2017 received a significantly lower mean fresh frozen plasma to red blood cells (FFP:RBC) compared to patients aſter July 2017. CONCLUSIONS: Trauma patients with major haemorrhage at Christchurch Hospital are still receiving excess crystalloids; however, our audit suggests that compliance with the MTP has improved. Further education involving the entire trauma team is required to improve fluid resuscitation practice. ARTICLE