The role of early intravenous crystalloid bolus in adult sepsis resuscitation in the emergency department
Gabor, X and Allen, P and Norman, S and Kanizsai, PL, The role of early intravenous crystalloid bolus in adult sepsis resuscitation in the emergency department, Orvosi Hetilap, 161, (39) pp. 1-7. ISSN 0030-6002 (2020) [Contribution to Refereed Journal]
Based on the 2018 update of the Surviving Sepsis Campaign, the Committee for Quality Improvement of the
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.