By Tom Vogt
The Columbian (Washington)
Copyright 2006 The Columbian
Distributed by McClatchy-Tribune Business News
Local trauma victims and paramedics will be part of a study on improving survival rates of seriously injured people.
The study will be conducted by Oregon Health & Science University, one of 11 medical centers involved in the National Institutes of Health project.
OHSU has received approval to move forward with a study to determine whether a stronger saline solution can help people survive traumatic injuries. OHSU will oversee the study in Clark County and three Portland-area counties.
“When we have people with low blood pressure and a head injury, we want to give them enough fluid to bring their blood pressure up, but not so much to cause brain swelling,” said Roxy Barnes, emergency medical services administrator for the Vancouver Fire Department.
Paramedics now treat trauma victims with intravenous saline solution water with the same salt content as blood, about 0.9 percent. This study will determine whether hypertonic saline (7.5 percent salt) improves survival or recovery of brain function.
In basic measurements, for each cup of blood lost, paramedics must administer from four to eight cups of standard intravenous fluid, she said.
“Too much fluid increases brain swelling, which is something we can’t fix,” Barnes said.
The hypertonic solution “creates the ability for fluid to be drawn into the blood vessels,” Barnes said. “It doesn’t add fluid to the body as much as it uses fluid already there.”
Only one cup of the hypertonic solution will be given to a patient.
Another fluid also will be part of the study, a hypertonic saline solution with dextran an added sugar molecule thought to aid recovery of brain function.
“We really need to test these options. Otherwise, we’re basing our treatment on our best guess,” said Dr. Jerris Hedges, principal researcher and vice dean of the OHSU School of Medicine.
Because the patients will be seriously injured, they won’t be able to provide their consent, which usually is required for participants in a medical study.
That’s why the study will be conducted under Food and Drug Administration regulations that allow research of emergency treatments in life-threatening situations without the patient’s consent.
Southwest Washington Medical Center in Vancouver was part of the approval process, and will provide trauma care for some of the study subjects.
The study begins in about two weeks. It will continue until 3,000 patients in the 11 study regions have been included.
“We expect 75 to 150 patients in this area,” Hedges said.
To be eligible, subjects must have severe injuries with low blood pressure or an altered mental state due to head injury. OHSU expects most eligible subjects to be victims of vehicle crashes. Women who are obviously pregnant, children 14 and younger and people under arrest won’t be eligible.
Most emergency-response agencies in Clark County but not all will take part part, Barnes said.
Paramedics won’t know if they are providing regular saline, hypertonic saline or hypertonic saline with dextran.
Bags will be bar-coded and scanned to determine later what the patient received. Those enrolled in the study and their family members will be informed as soon as possible.