Traumatic hemorrhagic shock (THS) is a complex physiological response triggered by severe trauma, characterized by the profound depletion of circulating blood volume [1,2]. This detrimental condition induces tissue hypoperfusion, disrupts cellular metabolism, and damages vital organ functions. In the initial phases of trauma, effective management of bleeding plays a pivotal role in preventing fatal outcomes. At the same time, fluid resuscitation enhances tissue perfusion and mitigates the risk of traumatic coagulopathy (TIC), thereby reducing the likelihood of secondary organ failure and mortality [[3], [4], [5], [6], [7]]. Our study builds upon these findings by underscoring the critical importance of promptly controlling the bleeding source, initiating early fluid resuscitation, and restoring intravascular volume and oxygen-carrying capacity in the clinical management of patients with Traumatic hemorrhagic shock (THS) [[8], [9], [10], [11]]. Nevertheless, selecting the most suitable resuscitation fluid for Traumatic hemorrhagic shock (THS) patients remains contentious, necessitating urgent attention and resolution in clinical THS treatment.

In recent years, numerous clinical investigations have consistently supported the notion that early administration of blood products is the optimal approach for fluid resuscitation [12]. Unfortunately, acquiring blood products promptly during the initial phases of trauma can often pose challenges. Furthermore, studies have indicated that pre-hospital plasma does not yield survival advantages in cases requiring swift ground support [13,14]. Historically, normal saline and sodium lactate Ringer's solution have been widely utilized as crystalloid options for resuscitation in clinical settings [15,16]. However, both solutions come with their limitations. Due to its high chloride ion content, normal saline can lead to hyperchloremic metabolic acidosis and disrupt water and electrolyte balance during rapid administration [17]. On the other hand, sodium lactate Ringer's solution (LRS) aims to avoid hyper chloremia but is associated with the possibility of exacerbating shock-induced lactic acidosis [18]. Lactate in LRS and acetate in sodium acetate Ringer's solution require hepatic metabolism [19,20], which may pose additional challenges in shock cases and compromised liver function [21]. In contrast, sodium bicarbonate Ringer's solution represents a novel formulation of the crystalloid solution containing essential ions such as sodium, magnesium, potassium, and calcium, as shown in Table 1 [22]. This unique solution has shown promise in replenishing circulating blood volume and ameliorating metabolic acidosis, making it a potentially beneficial alternative.

This meta-analysis aims to comprehensively review and synthesize existing clinical studies on the efficacy and safety of Bicarbonated Ringers solution (BRS), comparing different crystalloid resuscitation fluids, including normal saline and sodium lactate Ringer's solution, in managing traumatic hemorrhagic shock (THS).