Author Affiliations: Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Torrance.
In this issue of THE JOURNAL, Cooper and colleagues1 report
the results of a well-designed and well-executed randomized trial comparing
2 fluid resuscitation strategies in the initial prehospital treatment of adults
with severe traumatic brain injury and posttraumatic hypotension. Although
the results show no evidence of improved neurological outcome with the hypertonic
saline (HTS)–based resuscitation strategy, the study is noteworthy for
several reasons. First, it is one of relatively few examples of double-blind,
randomized controlled studies of therapies for critically ill patients conducted
in the prehospital setting.2,3 Such
studies are critically important to determine what works in that setting.
Second, the study illustrates several issues regarding obtaining informed
consent for participation in research from acutely incapacitated patients
in the prehospital setting. Third, the study results, although negative, may
be helpful in guiding choices of fluid resuscitation strategies in future
Lewis RJ. Prehospital Care of the Multiply Injured PatientThe Challenge of Figuring Out What Works. JAMA. 2004;291(11):1382-1384. doi:10.1001/jama.291.11.1382