Hypertonic Saline Resuscitation for Severe Traumatic Brain Injury Patients
Long term outcomes of patients with severe traumatic brain injury continue to be unfavourable. It is likely that secondary brain injury after trauma may be minimised and outcomes improved, by effective resuscitation and faster correction of secondary insults. Hypertonic saline (HTS) expands intra-vascular volume more rapidly than conventional resuscitation fluids, corrects hypotension, and decreases intracranial pressure. These features suggest that HTS may be an ideal resuscitation fluid for hypotensive patients with traumatic brain injury (TBI), especially in the pre-hospital setting. Previous trials have suggested benefit for HTS and HTS-dextran (HTSD) for pre-hospital TBI patients, and a commercial HTSD product is in use for pre-hospital resuscitation in many countries, but no randomised trial had been reported in this patient group.
We completed the first prospective randomised trial testing pre-hospital HTS in addition to conventional resuscitation protocols in 229 patients with non-penetrating traumatic coma and hypotension in Victoria Australia.1 We found that neurological outcomes (Extended Glasgow Outcome Score) at 3, 6 and 24 months after injury were the same as in the patients receiving standard resuscitation protocols. There was a small trend to improved survival but favourable outcomes were the same. In the context of an efficient pre-hospital paramedic system in Victoria Australia, HTS did not improve patient outcomes.
Hypertonic saline however continues to have likely advantages and be widely used for other indications in Intensive Care including the management of refractory intracranial hypertension.
1. Pre-hospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomised controlled trial. JAMA 2004;291:1350-1357
Supported by NHMRC, Victorian Trauma Foundation, ANZIC Foundation, Neurosurgical Research Foundation.