Hypertonic saline (HTS) in head injured patients - a multicentre, prehospital, prospective randomised clinical trial

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Head injury is common in patients with major trauma, many of whom are young adults. The extent of head injury has a major influence on patient outcome. Low blood pressure after trauma worsens the extent of brain injury by decreasing its blood supply at a critical stage. Much of this secondary brain injury occurs before the patient reaches hospital. Hypertonic saline (HTS) is an intravenous salt solution which has been used in intensive care patients for many years to decrease brain swelling in head injured patients. We know that HTS can be given to patients before they reach hospital, is safe, and acts by rapidly increasing blood pressure and decreasing brain swelling. Accordingly HTS may minimise secondary brain injury and lead to increased survival. Importantly, HTS is likely to dramatically improve neurological function of survivors without any significant risk of side effects. This study is designed to determine the effectiveness of prehospital HTS in head injured trauma patients with traumatic coma and low blood pressure.