title: Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial.
abstract: 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.
authors.affiliation: Department of Intensive Care, Alfred Hospital, Monash University, Melbourne, Victoria, Australia. j.cooper@alfred.org.au
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
authors.forename: Paul S
authors.initials: PS
authors.lastname: Myles
authors.forename: Francis T
authors.initials: FT
authors.lastname: McDermott
authors.forename: Lynette J
authors.initials: LJ
authors.lastname: Murray
authors.forename: John
authors.initials: J
authors.lastname: Laidlaw
authors.forename: Gregory
authors.initials: G
authors.lastname: Cooper
authors.forename: Ann B
authors.initials: AB
authors.lastname: Tremayne
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Bernard
authors.forename: Jennie
authors.initials: J
authors.lastname: Ponsford
mesh_terms: 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
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic