Hypertonic Saline In Cardiac Arrest

There is a physiologic phenomenon observed in animal studies that a small increase in plasma osmolarity using hypertonic saline increases microperfusion, including myocardial and cerebral blood flow.  Therefore, in theory, hypertonic saline administration during resuscitation from cardiac arrest should be efficacious in improving survival and neurologic outcome.

These authors conduct a randomized prospective trial in which they prove that 100 patients in each arm is not enough to make valid claims about a secondary endpoint for which the study was not designed to evaluate.  There is no difference between groups in mortality – and not even non-significant trends – but a small, significant, absolute difference in neurologic impairment, 4.9% without neurologic impairment in the control group and 13% in the intervention group.

So, another study suggesting further study is needed.  If anything, it demonstrates how impossibly hard it is to evaluate treatments in the heterogenous population of out-of-hospital cardiac arrest, and to ensure internal and external validity.

“Randomised study of hypertonic saline infusion during resuscitation from

out-of-hospital cardiac arrest.”

4 thoughts on “Hypertonic Saline In Cardiac Arrest”

  1. One part of the study I noticed was they were using Hespan as their baseline fluid for resus. I wasn't aware of any studies comparing Hespan to Normal Saline in cardiac arrest. I wonder if they just always use Hespan as their volume expansion agent.

  2. One part of the study I noticed was they were using Hespan as their baseline fluid for resus. I wasn't aware of any studies comparing Hespan to Normal Saline in cardiac arrest. I wonder if they just always use Hespan as their volume expansion agent.

  3. Good catch – but no, Hespan as a volume expander is definitely not something in routine use. I'm not up to date on the synthetic volume expanders other than to have heard Hespan has an association with renal failure.

  4. Good catch – but no, Hespan as a volume expander is definitely not something in routine use. I'm not up to date on the synthetic volume expanders other than to have heard Hespan has an association with renal failure.

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