Association of 6% hetastarch resuscitation with adverse outcomes in critically ill trauma patients

Matthew E. Lissauer, Albert Chi, Mary E. Kramer, Thomas M. Scalea, Steven B. Johnson

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Background Six percent hetastarch is used as a volume expander but has been associated with poor outcomes. The aim of this study was to evaluate trauma patients resuscitated with hetastarch. Methods A retrospective review was performed of adult trauma patients. Demographics, injury severity, laboratory values, outcomes, and hetastarch use were recorded. Results A total of 2,225 patients were identified, of whom 497 (22%) received hetastarch. There were no differences in age, gender, injury mechanism, lactate, hematocrit, or creatinine. The mean injury severity score was different: 29.7 ± 12.6 with hetastarch versus 27.5 ± 12.6 without hetastarch. Acute kidney injury developed in 65 hetastarch patients (13%) and in 131 (8%) without hetastarch (relative risk, 1.73; 95% confidence interval [CI], 1.30-2.28). Hetastarch mortality was 21%, compared with 11% without hetastarch (relative risk, 1.84; 95% CI, 1.48-2.29). Multivariate logistic regression demonstrated hetastarch use (odds ratio, 1.96; 95% CI, 1.49-2.58) as independently significant for death. Hetastarch use was independently significant for renal dysfunction as well (odds ratio, 1.70; 95% CI, 1.22-2.36). Conclusions Because of the detrimental association with renal function and mortality, hetastarch should be avoided in the resuscitation of trauma patients.

Original languageEnglish (US)
Pages (from-to)53-58
Number of pages6
JournalAmerican journal of surgery
Volume202
Issue number1
DOIs
StatePublished - Jul 2011

Keywords

  • Hetastarch
  • Shock/hemorrhage
  • Traumatology
  • Wounds and injuries

ASJC Scopus subject areas

  • Surgery

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