Who Invented the Parkland Formula?

Unanimously considered as the primary fluid resuscitation procedure for treating burn shock, the Parkland Formula is utilized in practically every burn center in the United States. It was invented by Charles R. Baxter, a doctor at the Parkland Memorial Hospital from which the formula got its name.

Located in Dallas, Texas, Parkland Memorial has a place in history as the hospital where the three principal figures involved in the 1963 assassination of US President John F. Kennedy had died; namely, President Kennedy himself, suspected gunman Lee Harvey Oswald, and Oswald’s killer Jack Ruby. It was in fact then-emergency room director Baxter himself who unsuccessfully attempted to save Kennedy’s life. He also performed surgery on Texas Governor John Connaly, who had been injured during the incident.

Dr. Baxter realized that severely-burned patients required an enormous amount of fluid in the first day of their treatment, particularly during the first 8 hours. It was in 1968 when he began developing the Parkland Formula based on studies he had conducted on animals and later tests on 11 burn patients. The method entailed administering Lactated Ringer’s (LR) at a rate of ml/kg/% burn, administering half the volume during the initial 8 hours and the other half over the following 16 hours, with the urine output being used as a clinical guide. Dr. Baxter would also specify that the plasma is to be administered at 0.3-0.5 ml/kg/% burn over the initial resuscitation’s fourth 8-hour interval; taking note that crystalloid in itself was not adequate enough to remedy the volume shortage. He would eventually report that the application of plasma had been based on research made with animals, and that employing the same process on human subjects did not evince a plasma volume increase superior in comparison to LR in the first 24 hours following injury.

After a decade of further research, Baxter would present his findings in 1979. He established that sufficient fluid resuscitation can be accomplished in most burn patients through the administration of crystalloids within the range of 3.7 ml-4.3 ml/kg/% burn. Baxter reported that out of 400 patients, the procedure yielded positive results on 70% of them, of which 12% needed more fluid and 18% needing less. He would make the following conclusions: that LR was effective as the preliminary and sole fluid replacement for burn patients during the initial 24 hours, restoring fluid volume spaces and hastening cardiovascular integrity; that only roughly 70% of an extensive burn patient population would need 4 cc/kg, with those suffering from cutaneous and electrical burns as, well as inhalation injuries requiring additional fluid; and that plasma could be administered any time after a burn injury, although it is especially effective if dispensed within a 24-30 hour period.

The development of the Parkland Formula was only one of the efforts made by Dr. Charles R. Baxter for the benefit of burn victims. He would also found a tissue bank in Parkland, making skin grafts available to burn patients. On a separate note, he was also supposed to have contributed to the creation of Gatorade. Dr. Baxter passed away from pneumonia at age 75 on March 10, 2005.

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