Abstract
Background6% Hydroxyethyl Starch 130/0.4 in 0.9% Sodium Chloride (Voluven®; 6% HES 130/0.4) is a colloid often used for fluid resuscitation in patients with subarachnoid hemorrhage (SAH), despite a lack of safety data for this use. The purpose of our study was to evaluate the effect of 6% HES 130/0.4 on major complications associated with SAH.MethodsMedical records of all patients presenting between May 2010 and September 2012 with aneurysmal SAH were analyzed. Patients were divided in two groups based on the administration of 6% HES 130/0.4; HES group (n=57) and Non-HES group (n=72). The primary outcome included a composite of three major complications associated with SAH: Delayed Cerebral Ischemia (DCI), Hydrocephalus (HCP) requiring cerebrospinal fluid (CSF) shunting, and Rebleeding.ResultsThe study groups were similar with respect to most characteristics except the incidences of hypertension, ischemic heart disease, Fisher grade and lowest hemoglobin during stay. The odds of developing the primary composite outcome was higher in the HES group [OR= 3.1(1.30-7.36), p=0.01]. The patients in the HES group had a significantly longer median duration of hospital (19 vs 14 days) and Neurointensive Care Unit stay (14 vs 10 days) compared to the Non HES group.ConclusionWe observed increased complications after SAH with 6% HES 130/0.4 (Voluven®) administration. An adequately powered prospective randomized controlled trial into the safety of 6% HES 130/0.4 in this patient population is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-314) contains supplementary material, which is available to authorized users.
Highlights
Aneurysmal Subarachnoid hemorrhage (SAH) has an incidence of nine cases per 100,000 patient years (de Rooij et al 2007), with 65% survival after the initial hemorrhage (Lovelock et al 2010; Nieuwkamp et al 2009)
Hydroxyethyl Starch (HES) based resuscitation fluids have been available for several years, with subsequent generations of HES differing in their mean molecular weight (Mw), Molar substitution (MS), C2/C6 hydroxyethylation ratio and solvent
Patients were excluded from analysis if they were incorrectly coded by ICD 9 classification, had SAH secondary to trauma or anticoagulation, if they had an SAH that was non-aneurysmal in nature, or where the source of SAH was not apparent
Summary
Aneurysmal Subarachnoid hemorrhage (SAH) has an incidence of nine cases per 100,000 patient years (de Rooij et al 2007), with 65% survival after the initial hemorrhage (Lovelock et al 2010; Nieuwkamp et al 2009). Hydroxyethyl Starch (HES) based resuscitation fluids have been available for several years, with subsequent generations of HES differing in their mean molecular weight (Mw), Molar substitution (MS), C2/C6 hydroxyethylation ratio and solvent (saline or balanced salt solution). Voluven® (Fresenius Kabi, Bad Homburg, Germany) is a colloid solution which consists of a maize derived 6% HES (Mw: 130 kDa, MS: 0.40, C2/C6 ratio 9:1) suspended in normal saline, which has been available in the United States since 2007. Recently there have been a number of publications in literature which describe the use of 6% HES 130/ 0.4, in patients which have had SAH (Lehmann et al 2013; Anonymous 2012; Moretti and Pizzi 2010)
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