Re: Coagulation and Fluid Resuscitation by HyperHES in Severe Hemorrhage

We sincerely appreciate the interest in and comment from Drs. Vico, Dubost, and Merat regarding our article of Comparisons of lactated Ringer s and Hextend resuscitation on hemodynamics and coagulation following femur injury and severe hemorrhage in pigs published in the Journal of Trauma and Acute Care Surgery. In our article, we reported that Hextend was effective in restoring hemodynamics and acid-base status with one-third volume of lactated Ringer s solution. However, this advantage was associated with undesired effects on coagulation possibly owing to greater and sustained hemodilution from Hextend resuscitation. Vico et al. reported that the French army uses HyperHES a colloid and 7.5 saline and suggested that HyperHES has the potential to be more effective in treating hypovolemic shock. We agree with their comments, since the effects on volume expansion have been reported in a large body of literature with 7.5 hypertonic saline as well as hypertonic saline with colloids such as dextran and hydroxyethyl starch.1Y4 However, we are unaware of studies evaluating the effects of HyperHES on coagulation after hemorrhagic shock. With well-documented effects of large molecular weight hydroxyethyl starch on coagulation and the findings of prolonged compromise in coagulation function from Hextend resuscitation in our study and by others in our group,5,6 additional research effort is warranted to determine the effects of HyperHES on hemostasis under trauma and hemorrhagic shock. Perhaps, the lower molecular weight starch of HyperHES may have less effect on coagulation, but this will require confirmation. In addition, only 3 and 5 hypertonic saline solutions are approved by the US Food and Drug Administration, and HyperHES is not an approved product available in United States.