Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial.
BACKGROUND
Prehospital hypertonic saline (HTS) resuscitation of patients with traumatic brain injury (TBI) may increase survival but whether HTS improves neurological outcomes is unknown.


OBJECTIVE
To determine whether prehospital resuscitation with intravenous HTS improves long-term neurological outcome in patients with severe TBI compared with resuscitation with conventional fluids.


METHODS
Double-blind, randomized controlled trial of 229 patients with TBI who were comatose (Glasgow Coma Scale score, <9) and hypotensive (systolic blood pressure, <100 mm Hg). The patients were enrolled between December 14, 1998, and April 9, 2002, in Melbourne, Australia.


METHODS
Patients were randomly assigned to receive a rapid intravenous infusion of either 250 mL of 7.5% saline (n = 114) or 250 mL of Ringer's lactate solution (n = 115; controls) in addition to conventional intravenous fluid and resuscitation protocols administered by paramedics. Treatment allocation was concealed.


METHODS
Neurological function at 6 months, measured by the extended Glasgow Outcome Score (GOSE).


RESULTS
Primary outcomes were obtained in 226 (99%) of 229 patients enrolled. Baseline characteristics of the groups were equivalent. At hospital admission, the mean serum sodium level was 149 mEq/L for HTS patients vs 141 mEq/L for controls (P<.001). The proportion of patients surviving to hospital discharge was similar in both groups (n = 63 [55%] for HTS group and n = 57 [50%] for controls; P =.32); at 6 months, survival rates were n = 62 (55%) in the HTS group and n = 53 (47%) in the control group (P =.23). At 6 months, the median (interquartile range) GOSE was 5 (3-6) in the HTS group vs 5 (5-6) in the control group (P =.45). There was no significant difference between the groups in favorable outcomes (moderate disability and good outcome survivors [GOSE of 5-8]) (risk ratio, 0.99; 95% confidence interval, 0.76-1.30; P =.96) or in any other measure of postinjury neurological function.


CONCLUSIONS
In this study, patients with hypotension and severe TBI who received prehospital resuscitation with HTS had almost identical neurological function 6 months after injury as patients who received conventional fluid.
Cooper
D James
DJ
Department of Intensive Care, Alfred Hospital, Monash University, Melbourne, Victoria, Australia. j.cooper@alfred.org.au
Myles
Paul S
PS
McDermott
Francis T
FT
Murray
Lynette J
LJ
Laidlaw
John
J
Cooper
Gregory
G
Tremayne
Ann B
AB
Bernard
Stephen S
SS
Ponsford
Jennie
J
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000628:therapy*; D004311:Double-Blind Method; D004632:Emergency Medical Services; D005260:Female; D005440:Fluid Therapy; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000628:therapy*; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D012151:Resuscitation; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D016896:Treatment Outcome
D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic