CARING FOR THE
CRITICALLY ILL PATIENT
Prehospital Hypertonic Saline Resuscitation
of Patients With Hypotension and
Severe Traumatic Brain Injury
A Randomized Controlled Trial
D. James Cooper, BMBS, MD
Paul S. Myles, MBBS, MD
Francis T. McDermott, MBBS, MD
Lynette J. Murray, BAppSci
John Laidlaw, MBBS
Gregory Cooper
Ann B. Tremayne
Stephen S. Bernard, MBBS
Jennie Ponsford, MA, PhD
for the HTS Study Investigators
SEVERE TRAUMATIC BRAIN INJURY
(TBI) is common in patients
with major trauma and typi-
cally involves young adultmen.1
Despite current management strate-
gies, patients with severe TBI have a
high mortality rate (31%-49%) and a
large number of survivors have persis-
tent severe neurological disability.1-4
There are 80000 to 90000 were cases
of survivors with long-term disability
after head injury annually in theUnited
States.5 The mean lifetime cost of each
TBI survivorwith severe disability from
TBI exceeds US $2 million.6
After initial head trauma, secondary
brain injury may occur due to
hypoxia, hypotension, or elevated
intracranial pressure (ICP) and is
associated with a worse neurological
outcome.3,7 Patients with hypotension
after severe TBI have twice the mor-
tality rate of normotensive patients.5
Therefore, aggressive resuscitation
with intravenous fluids is recom-
mended in current guidelines for the
management of patients with severe
TBI.8 Treatment of increased ICP in
patients with TBI is also likely to
improve outcomes.3
AuthorAffiliations andParticipatingCenters of theHTS
Study Investigators are listed at the end of this article.
CorrespondingAuthor: D. James Cooper, BMBS,MD,
Intensive Care Department, Alfred Hospital, Com-
mercial Road, Melbourne, Victoria, Australia 3004
(j.cooper@alfred.org.au).
Caring for theCritically Ill Patient Section Editor:Debo-
rah J. Cook, MD, Consulting Editor, JAMA.
Advisory Board: David Bihari, MD; Christian
Brun-Buisson, MD; Timothy Evans, MD; John
Heffner, MD; Norman Paradis, MD; Adrienne
Randolph, MD.
Context Prehospital hypertonic saline (HTS) resuscitation