Hypertonic saline infusion during resuscitation from out-of-hospital cardiac arrest: a matched-pair study from the German Resuscitation Registry

Resuscitation. 2014 May;85(5):628-36. doi: 10.1016/j.resuscitation.2013.12.033. Epub 2014 Jan 23.

Abstract

Aim: Survival rates after out-of-hospital-cardiac-arrest (OHCA) differ widely between EMS systems. Since hypertonic saline appears to improve long-term outcome after OHCA, some local EMS systems have included it in their treatment protocols for OHCA. Our first aim was to give a quality review of one of these protocols. Our second aim was to assess whether short-term survival improves when hypertonic saline is used in resuscitation after OHCA.

Methods: Matched pairs were identified for the independent "return of spontaneous circulation (ROSC) after cardiac arrest" (RACA) score variables and for use of ACD-CPR, adrenaline, and amiodarone from the German Resuscitation Registry (GRR) for January 2000 to March 2011. Patients received either 2mlkg(-1) hypertonic saline with hydroxyethyl starch (7.2% NaCl with 6% hydroxyethyl starch 200,000/0.5, HyperHAES® [HHS]) infused intravenously within 10min during CPR according to local treatment protocols or standard of care CPR (NON-HHS). The primary endpoint was admission to hospital rate (with spontaneous circulation); secondary endpoint was ROSC rate in relation to RACA score.

Results: 322 matched pairs were defined for 14 variables. Predicted ROSC-rate using RACA-score was similar in HHS (44.63%) and NON-HHS (43.63%; p=0.440). In contrast, 190 (59.0%) HHS patients achieved ROSC compared with only 136 NON-HHS patients (42.2%; χ(2): p<0.0001). Short term survival measured as rate of "admission to hospital with spontaneous circulation" was achieved in 169 HHS patients (52.5%) versus 108 NON-HHS patients (33.5%) (OR 2.19; 95%CI: 1.592-3.009; χ(2): p<0.0001).

Conclusion: Locally implemented treatment protocols using hypertonic saline/HES after OHCA are safe and effective. Also, we verified that short-term survival rates were better in patients receiving HHS.

Keywords: Case control clinical trial; Hospital admittance rate; Hypertonic saline; Out-of-hospital-cardiac-arrest; RACA-score; Small volume resuscitation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation / methods*
  • Female
  • Germany / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Hydroxyethyl Starch Derivatives / administration & dosage
  • Hydroxyethyl Starch Derivatives / analogs & derivatives
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / epidemiology
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Plasma Substitutes / administration & dosage
  • Registries
  • Risk Factors
  • Saline Solution, Hypertonic / administration & dosage*
  • Treatment Outcome

Substances

  • Hydroxyethyl Starch Derivatives
  • Plasma Substitutes
  • Saline Solution, Hypertonic
  • hydroxyethylstarch 200