A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients

M. J. Vassar, R. P. Fischer, P. E. O'Brien, B. L. Bachulis, J. A. Chambers, D. B. Hoyt and J. W. Holcroft
Department of Surgery, University of California-Davis, Sacramento.

OBJECTIVE: To evaluate the use of 250 mL of a 7.5% sodium chloride solution, both with and without added dextran 70, for the prehospital resuscitation of hypotensive trauma patients. DESIGN: Double-blind randomized trial. SETTING: Six trauma systems served by helicopter transport. PATIENTS: Injured patients with systolic blood pressures less than 90 mm Hg at any time in the field or during helicopter transport. INTERVENTIONS: Infusion of study solution, in the field or during transport, followed by conventional isotonic solutions as needed. Solutions studied in four cohorts were as follows: (1) lactated Ringer's; (2) 7.5% sodium chloride (hypertonic saline); (3) 7.5% sodium chloride combined with 6% dextran 70; and (4) 7.5% sodium chloride combined with 12% dextran 70. MAIN OUTCOME MEASURES: Blood pressure response; survival to time of hospital discharge among the treatment groups; and survival compared with that predicted by norms from the Major Trauma Outcome Study (MTOS). RESULTS: The mean (+/- SD) change in systolic blood pressure on arrival in the emergency department was significantly higher in the hypertonic saline solution group than that in the lactated Ringer's solution group (34 +/- 46 vs 11 +/- 49 mm Hg, P < .03). Overall survival in the four treatment groups was 49%, 60%, 56%, and 45% (not statistically significant). Survival in the hypertonic saline solution group, however, was significantly higher than that predicted by the MTOS norms (60% vs 48%, P < .001). Survival to hospital discharge in patients with baseline Glasgow Coma Scale scores of 8 or less was correlated with treatment group (P < .05 by logistic regression and P < .01 by Cox proportional-hazards analysis; with survival in the hypertonic saline solution group [34%] vs lactated Ringer's solution group [12%]). CONCLUSIONS: Prehospital infusion of 250 mL of 7.5% sodium chloride is associated with an increase in blood pressure and an increase in survival to hospital discharge compared with survival predicted by the MTOS norms. Patients with low baseline Glasgow Coma Scale scores seem to benefit the most from 7.5% sodium chloride resuscitation. Hypertonic saline solution without added dextran 70 is as effective as the more expensive solutions that contain dextran 70.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Hypertonic Resuscitation of Hypovolemic Shock After Blunt Trauma: A Randomized Controlled Trial
Bulger et al.
Arch Surg 2008;143:139-148.
ABSTRACT | FULL TEXT  

Resuscitation of patients after traumatic brain injury
Hulme
Trauma 2008;10:55-63.
ABSTRACT  

Traumatic brain injury: assessment, resuscitation and early management
Moppett
Br J Anaesth 2007;99:18-31.
ABSTRACT | FULL TEXT  

Pediatric Head Injury
Atabaki
Pediatr. Rev. 2007;28:215-224.
FULL TEXT  

Considerations in Fluids and Electrolytes After Traumatic Brain Injury
Rhoney and Parker
Nutr Clin Pract 2006;21:462-478.
ABSTRACT | FULL TEXT  

Hypertonic saline dextran after burn injury decreases inflammatory cytokine responses to subsequent pneumonia-related sepsis
Horton et al.
Am. J. Physiol. Heart Circ. Physiol. 2006;290:H1642-H1650.
ABSTRACT | FULL TEXT  

Selective inhibition of polymorphonuclear neutrophils by resuscitative concentration of hypertonic saline
Choi et al.
Emerg. Med. J. 2006;23:119-122.
ABSTRACT | FULL TEXT  

Hypertonic Saline Dextran Improves Outcome After Hypothermic Circulatory Arrest: A Study in a Surviving Porcine Model
Kaakinen et al.
Ann. Thorac. Surg. 2006;81:183-190.
ABSTRACT | FULL TEXT  

Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence: [Le choix du liquide pour la reanimation du patient polytraumatise : une revue des donnees physiologiques, pharmacologiques et cliniques]
Boldt
Canadian J. Anesthesia 2004;51:500-513.
ABSTRACT | FULL TEXT  

Prehospital Hypertonic Saline Resuscitation of Patients With Hypotension and Severe Traumatic Brain Injury: A Randomized Controlled Trial
Cooper et al.
JAMA 2004;291:1350-1357.
ABSTRACT | FULL TEXT  

Salt of the earth or a drop in the ocean? A pathophysiological approach to fluid resuscitation
Gosling
Emerg. Med. J. 2003;20:306-315.
ABSTRACT | FULL TEXT  

The role of hypertonic saline dextran in trauma resuscitation
Perera and Porter
Trauma 2002;4:189-201.
ABSTRACT  

Management of Head Trauma*
Marik et al.
Chest 2002;122:699-711.
ABSTRACT | FULL TEXT  

Effects of Hypertonic (10%) Saline in Patients With Raised Intracranial Pressure After Stroke
Schwarz et al.
Stroke 2002;33:136-140.
ABSTRACT | FULL TEXT  

Which fluid to give?
Protheroe and Nolan
Trauma 2001;3:151-160.
ABSTRACT  

Crystalloids and colloids for volume replacement
Sutcliffe
Trauma 1999;1:115-123.
ABSTRACT  

Effects of Hypertonic Saline Hydroxyethyl Starch Solution and Mannitol in Patients With Increased Intracranial Pressure After Stroke
Schwarz et al.
Stroke 1998;29:1550-1555.
ABSTRACT | FULL TEXT  

Delayed Fluid Resuscitation of Head Injury and Uncontrolled Hemorrhagic Shock
Bourguignon et al.
Arch Surg 1998;133:390-398.
ABSTRACT | FULL TEXT  

Cardiopulmonary effects of 7.2% saline solution compared with gelatin infusion in the early postoperative period after coronary artery bypass grafting
FCPS et al.
J. Thorac. Cardiovasc. Surg. 1998;115:178-189.
ABSTRACT | FULL TEXT  

A Medical Disaster Response to Reduce Immediate Mortality after an Earthquake
Schultz et al.
NEJM 1996;334:438-444.
FULL TEXT