Efficacy of hypertonic saline dextran (HSD) in patients with traumatic hypotension: meta-analysis of individual patient data.

Small volume resuscitation, using hypertonic saline/hyperoncotic colloid solutions, effectively restores blood volume and cardiovascular function after hemorrhagic shock in experimental models (I). Clinical evaluation of trauma resuscitation using 7.5% saline/6% Dextran 70 (HSD), as to over all mortality, has been inconclusive (2-9). This inconclusiveness appears to be primarily a result of limited statistical power. However, efficacy has been demonstrated in subpopulations such as patients who subsequently require surgery. What was unique about these clinical trials was they were prospective randomized controlled double-blind studies (RCTs) of trauma patients treated with HSD (2-9). Using verified data collected from previous RCTs, we prospectively designed an individual patient data meta-analysis to assess the efficacy of HSD. Metaanalysis using individual patient data from multiple studies ranks high in the hierarchy of evidence. These methods also allow for assessment of the efficacy of HSD in improving survival in subpopula tions. We utilized rigorous experimental methods, including development of and adherence to a prospectively defined protocol for data acquisition and analysis, with blinding as to treatment assignments to avoid bias to the extent possible. Our objective was to evaluate the efficacy of HSD for initial treatment of trauma versus standard-of-care (SOC) treatment. Specifically, we evaluated the efficacy of a 250 ml infusion of HSD versus an equivalent infusion of isotonic solution for initial management of traumatic hypovolemia and improvement of survival rates.