Hyperviscous fluids: Better treatment for severe blood loss

The Advanced Trauma Life Support guidelines, recommend that emergency physicians first control bleeding and resuscitate with isotonic fluids. New research suggests hypertonic, hyperviscous fluids may be superior. Click here for more information.

Treating blood loss is a critical medical issue because trauma is the leading cause of death among North Americans 1 to 44 years old. Whether injured on the freeway or wounded in battlefield, loss of 40 percent or more of a patient’s blood is immediately life-threatening. Physicians and emergency workers must act quickly.

The majority of trauma deaths are due to severe brain injury or a dangerous condition resulting from blood loss called hypovolemic shock. When too little blood flows through the body’s organs, the heart begins beating rapidly, the skin becomes cold and pale, blood pressure plummets, and patients exhibit mental confusion. Hypovolemic shock can progress within a matter of one or two hours to organ failure and death.

The bible of trauma physicians and emergency workers, the Advanced Trauma Life Support (ATLS) guidelines, emphasize that physicians first control bleeding and then provide limited fluid resuscitation, a strategy known as "permissive hypotension" until control of hemorrhage is obtained. The ATLS guidelines, developed by the American College of Surgeons and adopted in more than 30 countries, were modified to lower the volume of isotonic fluids given after several studies demonstrated that sudden increases in blood pressure (without immediate bleeding control) would "pop" clots that the body forms to control bleeding.

Over several decades, studies involving humans and animals have evaluated hypertonic saline (up to 7.5 percent sodium chloride) versus isotonic saline (0.9 percent sodium chloride). Given intravenously, hypertonic solutions act like magnets, drawing fluid from tissues into the bloodstream, thereby increasing blood volume. Such hypertonic saline has not received the approval of the Food and Drug Administration for clinical use in the United States. Therefore, it is not part of ATLS guidelines.