Role of controlled hypotension in Resuscitation of Elderly Trauma Patients in Emergency Department, Egypt

Background: In the recent decade, a new paradigm in early trauma resuscitation especially in case of ongoing, uncontrollable bleeding has emerged. This paradigm change stresses on damage control resuscitation; a combination process of controlled hypotension, balanced resuscitation and damage control surgery. This study was designed to determine the impact of controlled hypotension as a factor in improving the outcome in traumatized elderly patients because vigorous fluid resuscitation is associated with a rebleeding and high mortality rate. Aim: This study was conducted to improve the resuscitation process and decrease the mortality rate of elderly trauma patients in the emergency department. Subjects and methods: This comparative cross-sectional study included elderly trauma patients (> 65 years old) presenting with traumatic hypovolemic shock who were admitted to the Emergency Department of Suez Canal University Hospital according to the inclusion and exclusion criteria. The patients were divided into two groups: Group 1, which received balanced resuscitation with controlled hypotension with the target systolic blood pressure being 90 mmHg, and Group 2, which received balanced resuscitation with the target systolic blood pressure being 100 mmHg. Results: After resuscitation, patients in the controlled hypotension group had significantly less severe base deficit than those in the group 2 ( p = 0.04). Meanwhile, regarding coagulopathy, patients in the controlled hypotension group had significantly lower international normalized ratio (<1.5) than those in the Group 2 ( p < 0.001). Moreover, we found that patients who took controlled hypotension have less mortality at the emergency room (21.6%) than those in the group 2 (35.1%) ( p = 0.04). Conclusion: The study reported a lower rate of mortality and acid deficit in the group managed by controlled hypotension. The results regarding the benefits of controlled hypotension in elderly trauma patients are optimistic. However, many confirmatory studies should be conducted.