Burn Resuscitation Practices in North America: Results of the Acute Burn ResUscitation Multicenter Prospective Trial (ABRUPT)

Authors

David G Greenhalgh
Robert Cartotto
Sandra L Taylor
Jeffrey R Fine
Giavonni M Lewis
David J Smith
Michael A Marano
Angela Gibson
Lucy A Wibbenmeyer
James H Holmes
Julie A Rizzo
Kevin N Foster
Anjay Khandelwal
Sarah Fischer
Mark R Hemmila
David Hill
Ariel M Aballay
Edward E Tredget
Jeremy Goverman
Herbert Phelan
Carlos J Jimenez
Anthony Baldea
Rajiv Sood

Language

English

Publication Date

3-1-2023

Journal

Annals of Surgery

DOI

10.1097/SLA.0000000000005166

PMID

34417368

PMCID

PMC8857312

PubMedCentral® Posted Date

3-1-2024

PubMedCentral® Full Text Version

Author MSS

Abstract

Objectives: ABRUPT was a prospective, noninterventional, observational study of resuscitation practices at 21 burn centers. The primary goal was to examine burn resuscitation with albumin or crystalloids alone, to design a future prospective randomized trial.

Summary background data: No modern prospective study has determined whether to use colloids or crystalloids for acute burn resuscitation.

Methods: Patients ≥18 years with burns ≥ 20% total body surface area (TBSA) had hourly documentation of resuscitation parameters for 48 hours. Patients received either crystalloids alone or had albumin supplemented to crystalloid based on center protocols.

Results: Of 379 enrollees, two-thirds (253) were resuscitated with albumin and one-third (126) were resuscitated with crystalloid alone. Albumin patients received more total fluid than Crystalloid patients (5.2 ± 2.3 vs 3.7 ± 1.7 mL/kg/% TBSA burn/24 hours), but patients in the Albumin Group were older, had larger burns, higher admission Sequential Organ Failure Assessment (SOFA) scores, and more inhalation injury. Albumin lowered the in-to-out (I/O) ratio and was started ≤12 hours in patients with the highest initial fluid requirements, given >12 hours with intermediate requirements, and avoided in patients who responded to crystalloid alone.

Conclusions: Albumin use is associated with older age, larger and deeper burns, and more severe organ dysfunction at presentation. Albumin supplementation is started when initial crystalloid rates are above expected targets and improves the I/O ratio. The fluid received in the first 24 hours was at or above the Parkland Formula estimate.

Keywords

Humans, Isotonic Solutions, Fluid Therapy, Prospective Studies, Retrospective Studies, Treatment Outcome, Crystalloid Solutions, Albumins, North America

Published Open-Access

yes

Recommended Citation

Greenhalgh, David G; Cartotto, Robert; Taylor, Sandra L; et al., "Burn Resuscitation Practices in North America: Results of the Acute Burn ResUscitation Multicenter Prospective Trial (ABRUPT)" (2023). Faculty, Staff and Student Publications. 5235.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5235