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.
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.


METHODS
Double-blind randomized trial.


METHODS
Six trauma systems served by helicopter transport.


METHODS
Injured patients with systolic blood pressures less than 90 mm Hg at any time in the field or during helicopter transport.


METHODS
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.


METHODS
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.
Vassar
M J
MJ
Department of Surgery, University of California-Davis, Sacramento.
Fischer
R P
RP
O'Brien
P E
PE
Bachulis
B L
BL
Chambers
J A
JA
Hoyt
D B
DB
Holcroft
J W
JW
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D003911:Dextrans / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004630:Emergencies; D015600:Glasgow Coma Scale; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015601:Injury Severity Score; D007552:Isotonic Solutions / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D012151:Resuscitation; D000077331:Ringer's Solution; D012965:Sodium Chloride / Q000494:pharmacology / Q000627:therapeutic use*; D012996:Solutions; D015996:Survival Rate; D014187:Transportation of Patients; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000503:physiopathology
D003911:Dextrans; D007552:Isotonic Solutions; D012996:Solutions; D012965:Sodium Chloride; D000077331:Ringer's Solution