Hypertonic saline infusion during resuscitation from out-of-hospital cardiac arrest: a matched-pair study from the German Resuscitation Registry.
OBJECTIVE
Survival rates after out-of-hospital-cardiac-arrest (OHCA) differ widely between EMS systems. Since hypertonic saline appears to improve long-term outcome after OHCA, some local EMS systems have included it in their treatment protocols for OHCA. Our first aim was to give a quality review of one of these protocols. Our second aim was to assess whether short-term survival improves when hypertonic saline is used in resuscitation after OHCA.


METHODS
Matched pairs were identified for the independent "return of spontaneous circulation (ROSC) after cardiac arrest" (RACA) score variables and for use of ACD-CPR, adrenaline, and amiodarone from the German Resuscitation Registry (GRR) for January 2000 to March 2011. Patients received either 2mlkg(-1) hypertonic saline with hydroxyethyl starch (7.2% NaCl with 6% hydroxyethyl starch 200,000/0.5, HyperHAES® [HHS]) infused intravenously within 10min during CPR according to local treatment protocols or standard of care CPR (NON-HHS). The primary endpoint was admission to hospital rate (with spontaneous circulation); secondary endpoint was ROSC rate in relation to RACA score.


RESULTS
322 matched pairs were defined for 14 variables. Predicted ROSC-rate using RACA-score was similar in HHS (44.63%) and NON-HHS (43.63%; p=0.440). In contrast, 190 (59.0%) HHS patients achieved ROSC compared with only 136 NON-HHS patients (42.2%; χ(2): p<0.0001). Short term survival measured as rate of "admission to hospital with spontaneous circulation" was achieved in 169 HHS patients (52.5%) versus 108 NON-HHS patients (33.5%) (OR 2.19; 95%CI: 1.592-3.009; χ(2): p<0.0001).


CONCLUSIONS
Locally implemented treatment protocols using hypertonic saline/HES after OHCA are safe and effective. Also, we verified that short-term survival rates were better in patients receiving HHS.
Department of Anaesthesiology and Intensive Care, Klinik am Eichert, ALB FILS Kliniken, Göppingen, Germany.
Christopher
C
Hahn
Department of Anaesthesiology and Intensive Care Medicine, Bonn University Hospital, Bonn, Germany.
Martin
M
Breil
Department of Anaesthesiology and Intensive Care Medicine, Bonn University Hospital, Bonn, Germany.
Jens Christian
JC
Schewe
Department of Anaesthesiology and Intensive Care, Klinik am Eichert, ALB FILS Kliniken, Göppingen, Germany.
Martin
M
Messelken
Department of Anaesthesiology and Intensive Care, Klinik am Eichert, ALB FILS Kliniken, Göppingen, Germany.
Stefan
S
Rauch
Department of Anaesthesiology and Intensive Care Medicine, Schleswig-Holstein University Hospital, Kiel Campus, Kiel, Germany.
Jan Thorsten
JT
Gräsner
Department of Anaesthesiology and Intensive Care Medicine, Schleswig-Holstein University Hospital, Lübeck Campus, Lübeck, Germany.
Jan
J
Wnent
Department of Anaesthesiology and Intensive Care Medicine, Schleswig-Holstein University Hospital, Lübeck Campus, Lübeck, Germany.
Stephan
S
Seewald
City of Münster Fire Department, Münster, Germany.
Andreas
A
Bohn
Department of Anaesthesiology and Intensive Care, Klinik am Eichert, ALB FILS Kliniken, Göppingen, Germany. Electronic address: Matthias.Fischer@af-k.de.
Matthias
M
Fischer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000031:analogs & derivatives; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D010952:Plasma Substitutes / Q000008:administration & dosage; D012042:Registries; D012307:Risk Factors; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D016896:Treatment Outcome
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; C517718:hydroxyethylstarch 200
Case control clinical trial; Hospital admittance rate; Hypertonic saline; Out-of-hospital-cardiac-arrest; RACA-score; Small volume resuscitation