Abstract
Background: Polytrauma with haemorrhagic shock is a leading cause of mortality globally and in South Africa. Current clinical practice guidelines for prehospital emergency care emphasise the importance of restricting volumes of crystalloid fluid used in the treatment of haemorrhagic shock. Consequently, it has been observed that prehospital emergency care personnel may have a lower threshold for administering adrenaline infusions in such patients in order to avoid profound hypotension even though this use of adrenaline is not currently recommended. This study aimed to investigate the effect of prehospital adrenaline infusions on the mortality of polytrauma patients with haemorrhagic shock in South Africa.
Methods: A retrospective cohort design was used to estimate emergency department and hospital mortality of polytrauma patients with haemorrhagic shock who had and had not received prehospital adrenaline infusions. Clinical data was extracted from hospital records of four Level 1 trauma centres between 2019 to 2024 which included both prehospital and hospital data. Logistic regression analysis was used to assess the relationship between exposure and outcome. Both univariate and multivariate regression analysis was utilised to obtain unadjusted and adjusted odds ratios. Finally, propensity score matching was used to control selection bias between the groups and statistical models were adjusted for a range of confounding variables.
Results: In a sample of 902 cases, 18% received prehospital adrenaline infusions. Of the cases that received prehospital adrenaline infusions 12% died in the emergency department and 43% died in hospital. The emergency department mortality rate was three times higher in cases that received prehospital adrenaline infusions compared to those that did not. Hospital mortality rates were 2,4 times higher in patients that received prehospital adrenaline infusions compared to those that did not. Propensity score matched results showed a non-significant increase of 6% in emergency department mortality and a significant increase of 17%in hospital mortality for patients receiving prehospital adrenaline infusions.
Conclusion: In a bias-adjusted study investigating the effects of prehospital adrenaline infusions on mortality in patients with haemorrhagic shock, adrenaline infusions were associated with a 17% increase in post-emergency department mortality.