Hypertonic Sodium Chloride Solutions for the Prehospital Management of Traumatic Hemorrhagic Shock: a Possible Improvement in the Standard of Care?

Acute hemorrhage is a major cause of death in both civilian and military trauma. The suboptimal effect of the volume of standard crystalloids that can be infused during transport has resulted in a need for a more efficacious fluid for the prehospital management of both civilian and military trauma. Markedly hypertonic sodium chloride solutions have been shown to improve transiently the hemodynamic consequences of shock in animal models. The use of small volumes of 7.5% NaCl in 6% dextran 70 has resulted in a solution superior to equal volumes of standard crystalloids in the ability to resuscitate animals from hemorrhagic shock. The hypertonic sodium chloride/dextran solution has the potential advantages of improving survival, producing a beneficial hemodynamic effect with smaller fluid volumes, reducing total fluid requirements during resuscitation, and being stored easily. This solution may prove valuable in the early resuscitation of the hypovolemic trauma patient and merits further clinical trials.