Comparison of hypertonic saline/dextran versus hypertonic saline/hetastarch for resuscitation of hypovolemia

In the present study, we compare resuscitation of bled sheep with hypertonic saline/dextran or hypertonic saline/hetastarch. Unanestherized sheep were subjected to 2h of hemorrhagic hypotension and then resuscitated with 200 ml of 7.5% NaCl solution made up to include either 6% dextran 70 (Macrodex) or 6% hetastarch (Hespan). Both solutions provided an immediate and sustained improvement in arterial pressure and cardiac output. The hypertonic saline/dextran provided a slightly better overall response as mean arterial pressure, cardiac output and central venous pressure were higher in the dextran group at all times post resuscitation. However, only the ddifferences in arterial pressure and initial plasma volume expansion were statistically significant. The somewhat better response to hypertonic saline/dextran may be explained by the higher oncotic pressures generated by dextran compared to equal concentrations of hetastarch

Resuscitation of hemorrhage with intraosseous infusion of hypertonic saline/dextran

We resuscitated unanesthetized bled sheep (bled volume = 1.2-1.7 liters) with 200 ml of hypetonic saline/dextran 70 infused either through a peripheral vein (n=6) or directly into the red marrow of the sternum (n = 6). Intraosseous infusion of the viscous 7.5% NaCl/6% dextran solution required 2-4 min. Plasma sodium was rapidly increased to the same level n both groups demonstrating equally rapid entry into the vascular space. Both regimens provide rapid and sustained normalization of arterial pressure and cardiac output. No significant differences between the two groups were apparent for any measured variable. Intraosseous infusion of hypertonic resuscitation fluids merits further research to evaluate the safety and efficacy for prehspital treatment of hypovolemia and trauma