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Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

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Updated: May 10, 2026

Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine
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Published on: January 30, 2020

Starch safety in resuscitation - when will we ever learn?

Andy Parrish1, Marc Blockman

  • 1Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, South Africa. andygp@mweb.co.za

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|June 4, 2013
PubMed
Summary

Hydroxyethyl starches (HES) show no survival benefit for fluid resuscitation and may increase mortality in sepsis. Reviews indicate a higher risk of kidney damage, questioning HES

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Area of Science:

  • Critical care medicine
  • Nephrology
  • Pharmacology

Background:

  • Recent clinical trials and systematic reviews question the efficacy and safety of hydroxyethyl starches (HES) in fluid resuscitation.
  • Concerns exist regarding increased mortality in severe sepsis and potential renal harm associated with HES use.

Purpose of the Study:

  • To evaluate the survival benefit and renal safety of hydroxyethyl starches (HES) in fluid resuscitation.
  • To critically assess the existing literature, including industry-affiliated reviews, on HES efficacy and safety.

Main Methods:

  • Systematic reviews and meta-analyses of clinical trials involving hydroxyethyl starches for fluid resuscitation.
  • Analysis of mortality data and renal replacement therapy requirements in patients treated with HES.

Main Results:

  • High-quality systematic reviews show a non-significant increased relative risk of death (1.08-1.10) with HES use.
  • A significant 25% increased likelihood of requiring renal replacement therapy was observed with HES administration.
  • Concerns regarding the quality of some industry-affiliated reviews and potential bias in efficacy assessments.

Conclusions:

  • Current evidence suggests hydroxyethyl starches (HES) do not provide a survival benefit and may pose risks, particularly renal harm, in fluid resuscitation.
  • Re-evaluation of traditional efficacy endpoints is warranted given the identified safety concerns.
  • While newer HES formulations show promise on surrogate endpoints, current trials are underpowered to confirm safety.