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Observational Study
. 2023 Mar 1;277(3):512-519.
doi: 10.1097/SLA.0000000000005166. Epub 2021 Aug 19.

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

David G Greenhalgh  1 , Robert Cartotto  2 , Sandra L Taylor  3 , Jeffrey R Fine  3 , Giavonni M Lewis  4 , David J Smith Jr  5 , Michael A Marano  6 , Angela Gibson  7 , Lucy A Wibbenmeyer  8 , James H Holmes  9 , Julie A Rizzo  10 , Kevin N Foster  11 , Anjay Khandelwal  10 , Sarah Fischer  12 , Mark R Hemmila  13 , David Hill  14 , Ariel M Aballay  15 , Edward E Tredget  16 , Jeremy Goverman  17 , Herbert Phelan  18 , Carlos J Jimenez  19 , Anthony Baldea  20 , Rajiv Sood  21   22
Affiliations
Observational Study

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

David G Greenhalgh et al. Ann Surg. .

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.

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Conflict of interest statement

ABRUPT Financial Disclosures: Conflict of Interest: A.G.: Consultant for Mallinckrodt, Inc.; L.A.W.: Research support from Avita, Inc., MEDIWound, Inc., Mallincrodt, Inc.; J.H.H.: Equity in Abbott Labs, AbbVie, Change Healthcare, Imbed Biosciences, and consultant for Avita, Inc. and Mallinckrodt, Inc.; K.N.F.: Consultant for Baxter, Integra, Inc., Skingenix; A.K.: Consultant for Avita, Inc. The authors report no conflicts of interest.

Figures

Figure 1:
Figure 1:
A) The Input/Output ratio for crystalloid versus albumin treatment reveals a much higher ratio for patients treated with albumin. B) The pattern persists when breaking the albumin group into albumin ≤ 12 hours, albumin > 12 hours and crystalloid.
Figure 1:
Figure 1:
A) The Input/Output ratio for crystalloid versus albumin treatment reveals a much higher ratio for patients treated with albumin. B) The pattern persists when breaking the albumin group into albumin ≤ 12 hours, albumin > 12 hours and crystalloid.
Figure 2:
Figure 2:
The I/O ratio in patients who were given albumin. Hour 0 is the point of albumin initiation. Hours with a negative value are the hours before albumin was started and hours with a positive value are the hours after albumin starts.
Figure 3:
Figure 3:
The total crystalloid volume provided for the three groups (crystalloid, albumin ≤ 12 hours and albumin > 12 hours). Greater volumes were provided in the albumin ≤ 12 hours group, followed by the > 12 hours and least in the crystalloid only group.
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References

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