A Prospective, Randomized, Multicenter Trial Comparing Lactated Ringer’s Alone or With 5% Albumin for Resuscitation of Large Burns The Acute Burn ResUscitation Multicenter Prospective Trial 2 (ABRUPT2)

Objective: ABRUPT2 was a prospective, randomized, multicenter trial to determine whether lactated Ringer’s + 5% albumin (Alb) reduces resuscitation requirements compared to lactated Ringer’s (LR) alone in major burns. Summary Background Data: The prospective, observational, multicenter ABRUPT study(1) found that initiation of albumin rapidly lowered fluid input and improved urine output in patients with burns ≥ 20% TBSA. Methods: Based on the ABRUPT trial, inclusion was increased to ≥ 25% TBSA and ≥ 20% full-thickness. Patients ≥ 18 years were randomized to receive LR or Alb (2/3 LR + 1/3 5% albumin) for initial resuscitation. The initial rate was 2–4 ml/kg/% TBSA and adjusted to urine output (0.5–1 mL/kg/hour). For safety or excessive fluid volumes (> 250 mL/kg in 24 hours), investigators could crossover between assigned study arms. Results: The study was stopped at 99 subjects (Alb-48, LR-51) due to declining enrollment in 19/27 centers. Mean % TBSA burn was 46%. Twenty-six (51%) LR patients crossed over to Alb, but there were no crossovers from Alb to LR. Despite crossovers, following intention-to-treat, there were statistically significant (p 0.001) increased fluids at 24 and 48 hours for the LR group compared to Alb. The LR group averaged 1.5 (95% CI: 0.59,2.3) ml/kg/%TBSA and 2.1 (95% CI: 1.0,3.1) ml/kg/%TBSA times higher fluids compared to Alb at 24 and 48 hours, respectively. There were no differences in mortality, time to healing or acute kidney injury. Conclusion: The use of 5% albumin significantly reduced fluid requirements compared to LR alone in the first 48 hours after injury.