HYPERTONIC RESUSCITATION OF HYPOVOLEMIC SHOCK AFTER BLUNT TRAUMA

Abstract

The leading cause of late mortality after trauma is multiple organ failure syndrome, which is due to an excessive inflammatory response early after injury. Preclinical studies demonstrate that hypertonicity alters the activation of inflammatory cells, leading to reduction in organ injury. Objective: To evaluate the impact of hypertonicity on organ injury following blunt trauma. Methods: Blunt trauma patients with a prehospital SBP ≤ 90mm Hg were randomized to received 250cc 7.5% hypertonic saline/6% dextran-70 (HSD) or lactated ringers (LR) as the initial resuscitation fluid. The primary endpoint was ARDS free survival at 28 days. Cox regression was used to adjust for confounding factors. A pre-planned subset analysis was performed for patients requiring > 10 units of PRBC in the first 24 hrs. Results: 209 patients were enrolled (110 HSD, 99 LR, 10/03-8/05). The study was stopped for futility after the 2nd interim analysis. Intention to treat analysis demonstrated no significant difference in ARDS free survival (HR 1.01, 95% CI: 0.63-1.6). There was improved ARDS free survival in the subset requiring >10u PRBC, but this represented only 19% of the population (HR 2.18, 95% CI 1.09-4.36). Conclusions: No significant difference in ARDS free survival was demonstrated overall, with benefit in the subgroup of patients requiring > 10u PRBC in the first 24 hours. Massive transfusion is a better predictor of ARDS than prehospital hypotension. HSD may offer benefit in patients at highest risk for ARDS.Figure