New Saline Study Set to Begin

[Guest alsfirefighter]

New Saline Study Set to Begin

Local medics are ready to start testing a new method of revival on trauma victims who are too badly hurt to give their consent.

Last year, Portland was scheduled to join several other U.S. and Canadian cities in testing hypertonic saline, a concentrated salt solution meant to replace lost blood. But the study was suspended while doctors worked out how to test and track patients who got the solution after they were admitted to a hospital.

Those procedures have been settled, and ambulance crews in Clackamas and Washington counties were ready to enroll trauma victims in the study as of Tuesday, said Liana Haywood, a spokeswoman for Oregon Health & Science University, which is leading the local portion of the trial. Clark County will be ready to enroll test subjects Monday, with Multnomah County joining Jan. 15.

The saline study is unusual because the people subjected to the test can't agree to the experiment beforehand. That advanced permission, called "informed consent," is central to most medical experiments. But the saline solution is being used on trauma victims too badly hurt to give normal consent. So the trial is being run under a federal rule that allows lifesaving treatments to be tested on patients who can't consent.

Most people who receive the solution will probably be car-crash victims. People who have lost lots of blood or suffered severe brain injuries will either get normal saline solution or one of two more concentrated versions given at the trauma scene. Those patients will get blood, if needed, once they get to a hospital and be told about the study once they are conscious and thinking clearly. In Portland, doctors expect to enroll 50 to 100 people a year for blood loss and three to four times that number for head trauma. Women who are obviously pregnant, children 14 and younger, and people under arrest are excluded from the trial.

Doctors hope the salty solution will help some of the 100,000-plus U.S. residents killed by trauma each year. Now, paramedics give those people a standard saline solution to replace lost blood. (Ambulances don't carry blood because it is too perishable.) Some researchers think a solution containing more salt will limit brain swelling or a life-threatening inflammation that sometimes destroys organs days after a trauma.

Earlier and smaller studies of concentrated saline have not resulted in bad side effects or proved the saltier liquid is better. Doctors do know that the concentrated solution raises the body's sodium level. The new study procedures say hospitals must test a patient's sodium level three times in the day after they are enrolled in the trial and requires someone on the hospital staff to be knowledgeable about the study.

While no one involved will give normal consent, doctors made several presentations about the study around Portland last year to gauge the community's feedback, as required by federal law. Hospital and county administrators have also approved the test.

People who want to avoid the trial can get a bracelet to wear that signals they do not want to take part by e-mailing their name and mailing address to or calling 503-494-7015. About 350 people have received bracelets so far, Haywood said.

Andy Dworkin: 503-221-8239

[Guest paramedico987]

Just curious... anybody know what the crytalloid concentrations are that are being tested?

[Guest partyrock]

Nice to finally see this beeing tested large scale. I remember reading about this years ago.

Anyone read anythign recently on withholding standard saline to prevent dilution?

[Jybehofd 85]

Nice to finally see this beeing tested large scale.  I remember reading about this years ago.

Anyone read anythign recently on withholding standard saline to prevent dilution?

←

Well I can't say that I have read something but on a few lecuttures down in the city that its better to get the patient to the hospital then spend time on-scene getting 2 large IVs in. I do have some numbers but I am not sure exactly where I put the ditto, but it bascily broke it down that less is more unless the patient has a systolic below 90.

I am not too keen on the saline idea, granted whole blood is what they need, fallowed by backed plateles, and some where near the bottom before saline is Lactated Ringers. Anything has to be better then saline especially if it can carry some O2 for gas exchange.

Edited January 19, 2007 by Jybehofd

[Guest partyrock]

Thanks, anything you can find would be helpful. I'm sure LAS can correct me if I'm wrong, but I believe the purpose of the hypertonic saline isn't so much to replace lost fluids but to counteract the swelling of tissues.

[Guest alsfirefighter]

Tissue and organ swelling reduction is one thought I have.

The other is perhaps they are also thinking the resultant fluid shift from the hypertonic solution being in the circulatory system will pull fluid from the interstital spaces to aid in volume.

Also..something tells me that this has already been tried on the battle field and now they are doing the study on the streets which is common.

[WAS967 97]

Alot of the studies and journal articles about hypertonic solution therapy has been in regards to Traumatci Brain Injury (TBI). For hypovolemic shock and TBI alike, I'm more excited about something like this:

http://www.popsci.com/popsci/science/9e367...bccdrcrd/5.html

Better Than Blood?

A man-made, pure-white compound called Oxycyte carries oxygen 50 times as effectively as our own blood. Researchers are betting that it’s the best way to treat America’s leading cause of accidental death: traumatic brain injury

Edited February 20, 2007 by WAS967

[RWC130 594]

I thought D5W and Sodium Bicarb was the cure for everything?

That is what RAMPART always said! lol

[Guest skubasam]

Although specifically referring to septic shock, this link speaks to the positive effects of HSS therapy.

http://www.pubmedcentral.nih.gov/articlere...bmedid=12398781