Hypertonic fluids & traumatic brain injury

A Resuscitation Outcomes Consortium double-blind, randomized, placebo-controlled trial published Oct. 6 by JAMA involved 114 EMS agencies in the U.S.1 The trial sought to determine whether out-of-hospital administration of hypertonic fluids improves neurologic outcome in patients with traumatic brain injury.


Conducted between May 2006 and May 2009, the study included patients age 15 or older with blunt trauma and a prehospital Glasgow Coma Scale score of 8 or less that didn’t meet the criteria for hypovolemic shock. Patients received, in the prehospital setting, a single 250-mL bolus of 7.5% saline/6% dextran 70 (hypertonic saline/dextran), 7.5% saline (hypertonic saline) or 0.9% saline (normal saline).


The researchers’ conclusion was, “Among patients with severe TBI not in hypovolemic shock, initial resuscitation with either hypertonic saline or hypertonic saline/dextran, compared with normal saline, did not result in superior 6-month neurologic outcome or survival.”


  1. Bulger EM, May S, Brasel KJ, et al.   “Out-of-hospital hypertonic resuscitation following severe traumatic brain injury.” JAMA. 2010;304:1455—1464. doi:10.1001/jama.2010.1405

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