Hextend (BioTime, Inc., Berkeley, CA) is a new plasma volume expander containing 6%
hetastarch, balanced
electrolytes, a
lactate buffer, and physiological levels of
glucose. In preclinical studies, its use in
shock models was associated with an improvement in outcome compared with alternatives, such as
albumin or 6%
hetastarch in saline. In a prospective, randomized, two-center study (n = 120), we compared the efficacy and safety of Hextend versus 6%
hetastarch in saline (HES) for the treatment of
hypovolemia during major surgery. Patients at one center had a blood sample drawn at the beginning and the end of surgery for thromboelastographic (TEG) analysis. Hextend was as effective as HES for the treatment of
hypovolemia. Patients received an average of 1596 mL of Hextend: 42% received >20 mL/kg up to a total of 5000 mL. No patient received
albumin. Hextend-treated patients required less intraoperative
calcium (4 vs 220 mg; P < 0.05). In a subset analysis of patients receiving
red blood cell transfusions (n = 56; 47%), Hextend-treated patients had a lower mean estimated blood loss (956 mL less; P = 0.02) and were less likely to receive
calcium supplementation (P = 0.04). Patients receiving HES demonstrated significant prolongation of time to onset of clot formation (based on TEG) not seen in the Hextend patients (P < 0.05). No Hextend patient experienced a related serious adverse event, and there was no difference in the total number of adverse events between the two groups. The results of this study demonstrate that Hextend, with its novel buffered, balanced
electrolyte formulation, is as effective as 6%
hetastarch in saline for the treatment of
hypovolemia and may be a safe alternative even when used in volumes up to 5 L.
IMPLICATIONS: