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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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01-01-2019 | Editorials

Re-framing the question: Should hydroxyethyl starch be used in clinical practice?

Authors: Ryan Zarychanski, MD, MSc, FRCPC, Alexis F. Turgeon, MD, MSc, FRCPC

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 1/2019

Excerpt

The risk, benefits, and cost-utility of intravenous crystalloid and colloid fluids used in clinical medicine are the subject of active research and intense debate. The discussion concerning the use and safety of hydroxyethyl starch (HES) continues to feature prominently. In 2013, following the completion of three large randomized trials1-3 and a meta-analysis4 that showed hydroxyethyl starch to be associated with increased mortality and use of renal replacement therapy, Health Canada issued a warning against the use of HES in critically ill patients, specifically those with sepsis, severe liver disease, or impaired kidney function.5 Similar warnings about HES were issued by the Federal Drug Agency (FDA) and the European Medicines Agency (EMA).6 The EMA recommendation further restricted the use of HES to treat hypovolemia due to acute blood loss when crystalloids alone are not considered sufficient. …

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Zarychanski R, Abou-Setta AM, Turgeon AF, et al. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA 2013; 309: 678-88.CrossRefPubMed

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Pysyk CL, Boet S, Lalu M, Forster A, Bryson GL. Hydroxyethyl starch (HES) utilization before and after a regulatory safety warning. Can J Anesth 2018; 65: DOI: https://doi.org/10.1007/s12630-018-1244-6.

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Hong M, Jones PM, Martin J, et al. Clinical impact of disinvestment in hydroxyethyl starch for patients undergoing coronary artery bypass surgery: a retrospective observational study. Can J Anesth 2018; 65: DOI: https://doi.org/10.1007/s12630-018-1245-5.

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ClinicalTrials.gov. Safety and Efficacy of a 6% Hydroxyethyl Starch (HES) Solution Versus an Electrolyte Solution in Trauma Patients (TETHYS) - 2017. Available from URL:https://clinicaltrials.gov/ct2/show/NCT03338218?term=NCT03338218(accessed October 2018)

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ClinicalTrials.gov. Safety and Efficacy of 6% Hydroxyethyl Starch (HES) Solution Versus an Electrolyte Solution in Patients Undergoing Elective Abdominal Surgery (PHOENICS) - 2017. Available from URL:https://clinicaltrials.gov/ct2/show/NCT03278548(accessed October 2018)

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Title: Re-framing the question: Should hydroxyethyl starch be used in clinical practice?
Authors: Ryan Zarychanski, MD, MSc, FRCPC
Alexis F. Turgeon, MD, MSc, FRCPC
Publication date: 01-01-2019
Publisher: Springer International Publishing
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 1/2019
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-018-1246-4

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Re-framing the question: Should hydroxyethyl starch be used in clinical practice?

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