Small-volume resuscitation from hemorrhagic shock by hypertonic saline dextran -- conceptional basis and historical background.

Early and adequate fluid resuscitation is essential for the survival of the severely hypovolemic trauma patient. Studies have shown that, besides age, severity of injury and arterial hypotension, the duration of shock is the most important factor influencing the recovery from multiple trauma [1]. While for optimal resuscitation rapid restoration of blood volume is essential, the lack of compatible blood or blood components for infusion at the accident site has directed therapy towards the use of blood substitutes. The controversy regarding the relative merits of crystalloids and colloids for primary volume therapy has been exacerbated by conflicting results and, recently, by cost considerations. The increasing involvement of paramedics in the primary care of accident and emergency cases has highlighted the requirements for the ‘ideal’ solution for primary resuscitation. These are efficacy, practicability and safety. Early reports showed that, on average, only 500 to 1,000 ml of any fluid is given prior to hospital arrival [2]. Due to the short transportation intervals in many sites these data have not substantially changed. The crucial factor thus remains early and adequate resuscitation of the patient from shock with its characteristic sequelae of severely compromised microcirculation. This requirement has focused the interest in hypertonic saline/colloid solutions which, when given as small-volume bolus infusions, have a pronounced effect on the cardiovascular system. The data from both experimental and clinical studies suggest that these solutions should be particularly useful for primary resuscitation in severe trauma.