By Eileen Bulger, Guest Columnist
Tne Seattle Post-Intelligencer
Copyright 2006 Seattle Post-Intelligencer
Imagine yourself trapped in a car on Interstate 5 after a head-on collision. You are unconscious and have lost a significant amount of blood. You may have a severe brain injury. When paramedics arrive, they start intravenous fluids, critical to keeping you alive on the way to the hospital. The intravenous fluids currently used have been unchanged since their development in the 1960s.
University of Washington physicians based at Harborview Medical Center believe that a new intravenous fluid has the potential to improve your chances of survival. The fluid is a concentrated salt solution with or without a sugar component called Hypertonic Saline/Dextran (HSD). It will soon be tested in Seattle and nine other communities in the U.S. and Canada as part of a research study sponsored by the Resuscitation Outcomes Consortium, with funding from the National Institutes of Health.
Hypertonic fluids are expected to help accident victims survive by resulting in more rapid improvement of blood pressure, improved blood flow to the injured brain and decreased likelihood of high pressure in the brain. They may also decrease the risk of infection and lung injury by altering the immune response.
HSD is already approved for use in 14 European countries, including the United Kingdom, France, Germany, Sweden, Norway and Denmark. It has been tested previously in eight clinical trials in the U.S. and shown to improve survival. Potential side effects include allergic reaction to dextran, seizures due to very high salt levels in the blood and rapid increase in blood pressure leading to more bleeding. None of those side effects has been seen in the previous clinical trials.
Would you want paramedics to give you HSD for life-threatening injuries following an accident? When asked this question in a recent telephone survey, more than 78 percent of Seattle area respondents said they would welcome the treatment.
The Food and Drug Administration and the UW Human Subjects Review Committee have given researchers permission to do this study and enroll patients without their consent because HSD must be administered shortly after injury when patients may be unconscious and family members not immediately available. Once it is possible to do so, all participants or family members will be asked to give their informed consent to continue in the study.
During the three-year study period, HSD fluid will be carried by paramedics in Seattle and King County and by Airlift Northwest. It will be given to approximately 400 patients ages 15 and over with severe blood loss due to either blunt trauma (e.g., injuries caused by motor vehicle crashes) or penetrating trauma (e.g., bullet or stab wounds). It will also be given to patients with evidence of severe traumatic brain injury.
In 1970, Seattle became a model for emergency care in the field with the creation of Medic One at Harborview. We’re confident the new study will contribute to our continued leadership role in setting the best medical standards worldwide for pre-hospital emergency care.
Dr. Eileen Bulger is an attending physician at Harborview Medical Center and a UW associate professor of surgery. For more information, go to the study’s Web site at http://www.roctrauma.org or call 1-800-607-1879. Public comment is welcome.