Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension: The U.S.A. multicenter trial

Kenneth L. Mattox, Peter A. Maningas, Ernest E. Moore, James R. Mateer, John A. Marx, Charles Aprahamian, Jon M. Burch, Paul E. Pepe

Research output: Contribution to journalArticle

378 Citations (Scopus)

Abstract

The safety and efficacy of 7.5% sodium chloride in 6% dextran 70 (HSD) in posttraumatic hypotension was evaluated in Houston, Denver, and Milwaukee. Multicentered, blinded, prospective randomized studies were developed comparing 250 mL of HSD versus 250 mL of normal crystalloid solution administered before routine prehospital and emergency center resuscitation. During a 13-month period, 422 patients were enrolled, 211 of whom subsequently underwent operative procedures. Three hundred fifty-nine patients met criteria for efficacy analysis, 51% of whom were in the HSD group. Seventy-two per cent of all patients were victims of penetrating trauma. The mean injury severity score (19), Trauma Score plus Injury Severity Score (TRISS) probability of survival, revised trauma scores (5.9), age, ambulance times, preinfusion blood pressure, and etiology distribution were identical between groups. The total amount of fluid administered, white blood cell count, arterial blood gases, potassium, or bicarbonate also were identical between groups. The HSD group had an improved blood pressure (p = 0.024). Hematocrit, sodium chloride, and osmolality levels were significantly elevated in the Emergency Center. Although no difference in overall survival was demonstrated, the HSD group requiring surgery did have a better survival (p = 0.02), with some variance among centers. The HSD group had fewer complications that the standard treatment group (7 versus 24). A greater incidence of adult respiratory distress syndrome, renal failure, and coagulopathy occurred in the standard treatment group. No anaphylactoid nor Dextran-related coagulopathies occurred in the HSD group. Although this trial demonstrated trends supportive of HSD in hypotensive hemorrhagic shock patients requiring surgery, a larger sample size will be required to establish which subgroups of trauma patients might maximally benefit from the prehospital use of a small volume of hyperosmolar solution. This study demonstrates the safety of administering 250 mL 7.5% HDS to this group of patients.

Original languageEnglish (US)
Pages (from-to)482-491
Number of pages10
JournalAnnals of Surgery
Volume213
Issue number5
StatePublished - May 1991

Fingerprint

dextran - saline drug combination
Hypotension
Multicenter Studies
Injury Severity Score
Wounds and Injuries
Dextrans
Sodium Chloride
Survival
Emergencies
Blood Pressure
Safety
Ambulances
Hemorrhagic Shock
Adult Respiratory Distress Syndrome
Operative Surgical Procedures
Leukocyte Count
Hematocrit
Resuscitation
Sample Size
Osmolar Concentration

ASJC Scopus subject areas

  • Surgery

Cite this

Mattox, K. L., Maningas, P. A., Moore, E. E., Mateer, J. R., Marx, J. A., Aprahamian, C., ... Pepe, P. E. (1991). Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension: The U.S.A. multicenter trial. Annals of Surgery, 213(5), 482-491.

Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension : The U.S.A. multicenter trial. / Mattox, Kenneth L.; Maningas, Peter A.; Moore, Ernest E.; Mateer, James R.; Marx, John A.; Aprahamian, Charles; Burch, Jon M.; Pepe, Paul E.

In: Annals of Surgery, Vol. 213, No. 5, 05.1991, p. 482-491.

Research output: Contribution to journalArticle

Mattox, KL, Maningas, PA, Moore, EE, Mateer, JR, Marx, JA, Aprahamian, C, Burch, JM & Pepe, PE 1991, 'Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension: The U.S.A. multicenter trial', Annals of Surgery, vol. 213, no. 5, pp. 482-491.
Mattox KL, Maningas PA, Moore EE, Mateer JR, Marx JA, Aprahamian C et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension: The U.S.A. multicenter trial. Annals of Surgery. 1991 May;213(5):482-491.
Mattox, Kenneth L. ; Maningas, Peter A. ; Moore, Ernest E. ; Mateer, James R. ; Marx, John A. ; Aprahamian, Charles ; Burch, Jon M. ; Pepe, Paul E. / Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension : The U.S.A. multicenter trial. In: Annals of Surgery. 1991 ; Vol. 213, No. 5. pp. 482-491.
@article{599f9ca8e90e4e16b188c65a6cd245a8,
title = "Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension: The U.S.A. multicenter trial",
abstract = "The safety and efficacy of 7.5{\%} sodium chloride in 6{\%} dextran 70 (HSD) in posttraumatic hypotension was evaluated in Houston, Denver, and Milwaukee. Multicentered, blinded, prospective randomized studies were developed comparing 250 mL of HSD versus 250 mL of normal crystalloid solution administered before routine prehospital and emergency center resuscitation. During a 13-month period, 422 patients were enrolled, 211 of whom subsequently underwent operative procedures. Three hundred fifty-nine patients met criteria for efficacy analysis, 51{\%} of whom were in the HSD group. Seventy-two per cent of all patients were victims of penetrating trauma. The mean injury severity score (19), Trauma Score plus Injury Severity Score (TRISS) probability of survival, revised trauma scores (5.9), age, ambulance times, preinfusion blood pressure, and etiology distribution were identical between groups. The total amount of fluid administered, white blood cell count, arterial blood gases, potassium, or bicarbonate also were identical between groups. The HSD group had an improved blood pressure (p = 0.024). Hematocrit, sodium chloride, and osmolality levels were significantly elevated in the Emergency Center. Although no difference in overall survival was demonstrated, the HSD group requiring surgery did have a better survival (p = 0.02), with some variance among centers. The HSD group had fewer complications that the standard treatment group (7 versus 24). A greater incidence of adult respiratory distress syndrome, renal failure, and coagulopathy occurred in the standard treatment group. No anaphylactoid nor Dextran-related coagulopathies occurred in the HSD group. Although this trial demonstrated trends supportive of HSD in hypotensive hemorrhagic shock patients requiring surgery, a larger sample size will be required to establish which subgroups of trauma patients might maximally benefit from the prehospital use of a small volume of hyperosmolar solution. This study demonstrates the safety of administering 250 mL 7.5{\%} HDS to this group of patients.",
author = "Mattox, {Kenneth L.} and Maningas, {Peter A.} and Moore, {Ernest E.} and Mateer, {James R.} and Marx, {John A.} and Charles Aprahamian and Burch, {Jon M.} and Pepe, {Paul E.}",
year = "1991",
month = "5",
language = "English (US)",
volume = "213",
pages = "482--491",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension

T2 - The U.S.A. multicenter trial

AU - Mattox, Kenneth L.

AU - Maningas, Peter A.

AU - Moore, Ernest E.

AU - Mateer, James R.

AU - Marx, John A.

AU - Aprahamian, Charles

AU - Burch, Jon M.

AU - Pepe, Paul E.

PY - 1991/5

Y1 - 1991/5

N2 - The safety and efficacy of 7.5% sodium chloride in 6% dextran 70 (HSD) in posttraumatic hypotension was evaluated in Houston, Denver, and Milwaukee. Multicentered, blinded, prospective randomized studies were developed comparing 250 mL of HSD versus 250 mL of normal crystalloid solution administered before routine prehospital and emergency center resuscitation. During a 13-month period, 422 patients were enrolled, 211 of whom subsequently underwent operative procedures. Three hundred fifty-nine patients met criteria for efficacy analysis, 51% of whom were in the HSD group. Seventy-two per cent of all patients were victims of penetrating trauma. The mean injury severity score (19), Trauma Score plus Injury Severity Score (TRISS) probability of survival, revised trauma scores (5.9), age, ambulance times, preinfusion blood pressure, and etiology distribution were identical between groups. The total amount of fluid administered, white blood cell count, arterial blood gases, potassium, or bicarbonate also were identical between groups. The HSD group had an improved blood pressure (p = 0.024). Hematocrit, sodium chloride, and osmolality levels were significantly elevated in the Emergency Center. Although no difference in overall survival was demonstrated, the HSD group requiring surgery did have a better survival (p = 0.02), with some variance among centers. The HSD group had fewer complications that the standard treatment group (7 versus 24). A greater incidence of adult respiratory distress syndrome, renal failure, and coagulopathy occurred in the standard treatment group. No anaphylactoid nor Dextran-related coagulopathies occurred in the HSD group. Although this trial demonstrated trends supportive of HSD in hypotensive hemorrhagic shock patients requiring surgery, a larger sample size will be required to establish which subgroups of trauma patients might maximally benefit from the prehospital use of a small volume of hyperosmolar solution. This study demonstrates the safety of administering 250 mL 7.5% HDS to this group of patients.

AB - The safety and efficacy of 7.5% sodium chloride in 6% dextran 70 (HSD) in posttraumatic hypotension was evaluated in Houston, Denver, and Milwaukee. Multicentered, blinded, prospective randomized studies were developed comparing 250 mL of HSD versus 250 mL of normal crystalloid solution administered before routine prehospital and emergency center resuscitation. During a 13-month period, 422 patients were enrolled, 211 of whom subsequently underwent operative procedures. Three hundred fifty-nine patients met criteria for efficacy analysis, 51% of whom were in the HSD group. Seventy-two per cent of all patients were victims of penetrating trauma. The mean injury severity score (19), Trauma Score plus Injury Severity Score (TRISS) probability of survival, revised trauma scores (5.9), age, ambulance times, preinfusion blood pressure, and etiology distribution were identical between groups. The total amount of fluid administered, white blood cell count, arterial blood gases, potassium, or bicarbonate also were identical between groups. The HSD group had an improved blood pressure (p = 0.024). Hematocrit, sodium chloride, and osmolality levels were significantly elevated in the Emergency Center. Although no difference in overall survival was demonstrated, the HSD group requiring surgery did have a better survival (p = 0.02), with some variance among centers. The HSD group had fewer complications that the standard treatment group (7 versus 24). A greater incidence of adult respiratory distress syndrome, renal failure, and coagulopathy occurred in the standard treatment group. No anaphylactoid nor Dextran-related coagulopathies occurred in the HSD group. Although this trial demonstrated trends supportive of HSD in hypotensive hemorrhagic shock patients requiring surgery, a larger sample size will be required to establish which subgroups of trauma patients might maximally benefit from the prehospital use of a small volume of hyperosmolar solution. This study demonstrates the safety of administering 250 mL 7.5% HDS to this group of patients.

UR - http://www.scopus.com/inward/record.url?scp=0025910829&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025910829&partnerID=8YFLogxK

M3 - Article

C2 - 1708984

AN - SCOPUS:0025910829

VL - 213

SP - 482

EP - 491

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 5

ER -