The role of early intravenous crystalloid bolus in adult sepsis resuscitation in the emergency department

Based on the 2018 update of the Surviving Sepsis Campaign, the Committee for Quality Improvement of the National Health Services recommended instigating the elements of the Sepsis-6 bundle within one hour, including bolus infusion of 30 ml/kg crystalloids to adult patients screened positive for sepsis in the Emergency Department. In the UK, US and Australia compliance with this one-hour target became an important quality indicator, however, the supporting evidence may neither be contemporaneous nor necessarily valid for emergency medicine settings. A systematic review was designed to assess the evidence of mortality benefit associated with the intervention of early (<1 hour) administration of 30 ml/kg intra-venous crystalloids to adult patients screened positive for sepsis in the emergency department. The protocol was prospectively registered at PROSPERO. Five primary and multiple secondary databases were searched by librarians and a researcher for prehospital/ED/ICU related articles published between 2012–2019. Papers meeting the predefined inclusion criteria will be assessed individually in the systematic review. A random- or fixed-effects (where appropriate) meta-analysis will be conducted if feasible, otherwise Fisher’s combined p value will be calculated with a narrative synthesis. High quality, severity stratified evidence is needed to identify the exact patient cohort which would benefit from 30 ml/kg bolus crystalloid administration within 1 hour in the ED. Such research must investigate both the benefits and potential harms in the context of the pressing compliance target associated with the intervention.