title: Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial.
abstract: Small volume infusions of hypertonic saline combined with dextran are very effective in resuscitating animals that have been subjected to hemorrhagic shock, and seem to be effective in resuscitating trauma patients with severe injuries. In this study, the contribution of the dextran component was investigated in a prospective, three-armed, double-blind, randomized trial. Trauma patients transported by ambulance to the hospital with a systolic blood pressure of 90 mm Hg or less were given 250 mL of (1) normal saline (NS); (2) 7.5% NaCl (HS, for hypertonic saline); or (3) 7.5% NaCl in 6% dextran 70 (HSD). Infusion of the study solution was followed by administration of conventional isotonic fluids as the patients' conditions indicated. By predetermined hypothesis, the observed survival rates in the three treatment groups were compared with the predicted survival rates from the TRISS methodology. The 7.5% NaCl solution significantly improved upon the predicted survival for the entire cohort and for high-risk patients when compared with the survival estimates from the TRISS methodology. The addition of a colloid, in the form of 6% dextran 70, did not offer any additional benefit, at least in this setting of rapid urban transport.
authors.affiliation: Department of Surgery, School of Medicine, University of California, Davis Medical Center, Sacramento 95817.
authors.forename: M J
authors.initials: MJ
authors.lastname: Vassar
authors.forename: C A
authors.initials: CA
authors.lastname: Perry
authors.forename: J W
authors.initials: JW
authors.lastname: Holcroft
mesh_terms: D000328:Adult; D006259:Craniocerebral Trauma / Q000401:mortality; D003911:Dextrans / Q000008:administration & dosage*; D004311:Double-Blind Method; D004632:Emergency Medical Services; D006801:Humans; D007022:Hypotension / Q000628:therapy*; D015601:Injury Severity Score; D010865:Pilot Projects; D011446:Prospective Studies; D012044:Regression Analysis; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D003911:Dextrans; D012462:Saline Solution, Hypertonic