EFFICACY OF HYPERTONIC 7.5-PERCENT SALINE AND 6-PERCENT DEXTRAN-70 INTREATING TRAUMA - A METAANALYSIS OF CONTROLLED CLINICAL-STUDIES

Background. Individual trials of small-volume resuscitation of 7.5% Na Cl (HS) with and without 6% dextran 70 (HSD) for the treatment of trau ma have failed to provide convincing evidence of efficacy. We performe d a meta-analysis to evaluate the effects of HS and HSD on survival un til discharge or for 30 days. We identified eight double-blinded, rand omized controlled trials of HSD and six trials of HS. In all cases, ad ministration of 250 ml of HSD or HS was compared with a control group administration of 250 ml of isotonic crystalloid for the treatment of hypotension either in the field or at admission to the emergency depar tment. Methods. A fixed-effects meta-analysis was performed with the M antel-Haenszel method of combining results from multiple studies. Resu lts. Overall, HS was not effective in improving survival with a weight ed mean difference in survival of the HS group, versus the isotonic co ntrol group equal to 0.6%. The results with HSD were more positive, wi th an increase in survival in seven of eight trials. The mean differen ce in survival rates favoring HSD (n = 615) over controls (n = 618) wa s 3.5% (p = 0.14, two-tailed; p = 0.07, one-tailed). The odds ratio wa s estimated to be 1.20 in favor of HSD with a 95% confidence interval of 0.94 to 1.57. Conclusions. The meta-analysis of the available data shows that HS is not different from the standard of care and that HSD may be superior.