Prehospital Hypertonic Saline Resuscitation of Patients With Hypotension and Severe Traumatic Brain Injury

• DOI: 10.1001/jama.291.11.1350
• Publication Date: 2004-03-16T16:23:13Z
• Authors: D. James Cooper; Paul S. Myles; Francis T. McDermott; Lynette J. Murray; John Laidlaw; Gregory Cooper; Ann B. Tremayne; Stephen S. Bernard; Jennie Ponsford; for the HTS Stud...
• Keywords: Hypertonic saline; Interquartile range; Glasgow Outcome Scale

ContextPrehospital hypertonic saline (HTS) resuscitation of patients with traumatic brain injury (TBI) may increase survival but whether HTS improves neurological outcomes is unknown.ObjectiveTo determine prehospital intravenous long-term outcome in severe TBI compared conventional fluids.Design, Setting, and PatientsDouble-blind, randomized controlled trial 229 who were comatose (Glasgow Coma Scale score, <9) hypotensive (systolic blood pressure, <100 mm Hg). The enrolled between December 14, 1998, April 9, 2002, Melbourne, Australia.InterventionsPatients randomly assigned to receive a rapid infusion either 250 mL 7.5% (n = 114) or Ringer's lactate solution 115; controls) addition fluid protocols administered by paramedics. Treatment allocation was concealed.Main Outcome MeasureNeurological function at 6 months, measured the extended Glasgow Score (GOSE).ResultsPrimary obtained 226 (99%) enrolled. Baseline characteristics groups equivalent. At hospital admission, mean serum sodium level 149 mEq/L for vs 141 controls (P<.001). proportion surviving discharge similar both 63 [55%] group n 57 [50%] controls; P .32); rates 62 (55%) 53 (47%) control (P .23). median (interquartile range) GOSE 5 (3-6) (5-6) .45). There no significant difference favorable (moderate disability good survivors [GOSE 5-8]) (risk ratio, 0.99; 95% confidence interval, 0.76-1.30; .96) any other measure postinjury function.ConclusionIn this study, hypotension received had almost identical months after as fluid.