Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies.
BACKGROUND
Individual trials of small-volume resuscitation of 7.5% NaCl (HS) with and without 6% dextran 70 (HSD) for the treatment of trauma have failed to provide convincing evidence of efficacy. We performed a meta-analysis to evaluate the effects of HS and HSD on survival until discharge or for 30 days. We identified eight double-blinded, randomized controlled trials of HSD and six trials of HS. In all cases, administration of 250 ml of HSD or HS was compared with a control group administration of 250 ml of isotonic crystalloid for the treatment of hypotension either in the field or at admission to the emergency department.


METHODS
A fixed-effects meta-analysis was performed with the Mantel-Haenszel method of combining results from multiple studies.


RESULTS
Overall, HS was not effective in improving survival with a weighted mean difference in survival of the HS group versus the isotonic control group equal to 0.6%. The results with HSD were more positive, with an increase in survival in seven of eight trials. The mean difference in survival rates favoring HSD (n = 615) over controls (n = 618) was 3.5% (p = 0.14, two-tailed; p = 0.07, one-tailed). The odds ratio was estimated to be 1.20 in favor of HSD with a 95% confidence interval of 0.94 to 1.57.


CONCLUSIONS
The meta-analysis of the available data shows that HS is not different from the standard of care and that HSD may be superior.
Wade
C E
CE
Department of Neurobiology, Physiology, and Behavior, University of California, Davis, USA.
Kramer
G C
GC
Grady
J J
JJ
Fabian
T C
TC
Younes
R N
RN
D018849:Controlled Clinical Trials as Topic; D003911:Dextrans / Q000627:therapeutic use*; D004338:Drug Combinations; D006801:Humans; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017211:Treatment Failure; D014947:Wounds and Injuries / Q000188:drug therapy*
D003911:Dextrans; D004338:Drug Combinations; D012462:Saline Solution, Hypertonic