Treatment for hypovolemia

[DFIB]

I was doing some reading regarding an IV infusion called HEXTEND 6% Hetastarch in Lactated Electrolyte Injection.

Do any of you guys have any field information or or other knowledge regarding this product?

Is it hard to get?

Do you think it will replace Hartman's solution or Lactated Ringer's in the near future?

Edited May 26, 2012 by DFIB

[chbare]

It has been around for quite some time in a different form. Hespan + LR = Hextend. I do not see it replacing anything as currently we believe that limiting aggressive fluid resuscitation in certain patients is probably the best thing to do considering our current understanding of trauma resuscitation. Additionally, Hextend suffers from essentially the same pitfalls as standard crystalloids. It does not transport oxygen and it does not contain clotting factors.

You can do a little leg work and should be able to find the biggest Hextend study that I am aware of. It looked at just over 1,700 patients and there was a small but statistically significant decrease in mortality in patients who received Hextend. Unfortunately, there was a disporportionally higher need for blood transfusions and longer ICU stays in the Hextend patients. The significance of this finding is not known. The study was performed at Miami Ryder and completed around the 2009-2010 timeframe.

At this time, I am not convinced of it's absolute superiority, especially when we are developing techniques based around damage control resuscitation and component blood product therapy that appear to work well in the combat setting.

[Arctickat]

We have something that sounds similar called pentaspan. It's a starch based volume expander but has no oxygen carrying capacity. What I'd like to see is something like Hemopure. I believe it's based on bovine blood but can carry oxygen and isn't type specific.

[Arctickat]

Anyone got a protocol on coloid solutions such as pentaspan/pentastarch? I'm going to submit one for inter facility transports.

[rock_shoes]

The most recent thing I remember along these lines was when BCAS participated in the ROC trials.

Selected units carried hypertonic saline with or without Dextran. It was double blinded with three different solutions in play. Normal saline for a control and the two study fluids.

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[Arctickat]

We're not looking at initiation, yet, but for transport of a patient who has already started recieving the infusion prior to transport to the trauma centre. Protocol wouldn't matter though, initiation or transport only is fine.