Clinical Scorecard: Hydroxyethyl Starch for Prehospital Fluid Resuscitation: Findings from Two German Helicopter Emergency Medical Services

At a Glance

Key Highlights

• Across more than one million patient-contact missions in two German helicopter EMS databases, HES use declined over the observation periods.
• At ADAC, HES use fell from 3,104 cases (13.4%) in 2004 to 81 (0.2%) in 2022.
• At DRF, HES use fell from 1,564 cases (4.6%) in 2012 to 105 (0.3%) in 2022.
• The authors report that crystalloids now constitute the principal prehospital fluid therapy.
• The authors state that the safety of HES 130/04 for EMS use remains to be established, particularly for patients with major bleeding, circulatory shock, or impaired permeability.

Guideline-Based Recommendations

Diagnosis

Management

• The article reports that guidelines advised restricting crystalloid volumes to prevent overinfusion and dilution of coagulation factors, especially in trauma patients.
• The article states that European regulatory action nearly eliminated HES products from 2013 onward, with the phase-out completed by 2022.

Monitoring & Follow-up

Risks

• The article describes concerns about HES-associated hemostatic disturbances, bleeding complications, and organ failure.
• The authors state that elective-surgery evidence does not establish HES 130/04 safety for prehospital patients with major bleeding, circulatory shock, or impaired permeability.

Patient & Prescribing Data

The databases covered missions involving patient contact by ADAC and DRF helicopter EMS; patient-level clinical characteristics and outcomes were not reported.

HES use was rare by 2022 in both databases. The study describes utilization trends and does not compare patient outcomes or establish a preferred fluid regimen.

Clinical Best Practices

• The authors advise operators to recognize why HES products were abandoned and account for potential risks of organ failure and bleeding complications.
• The authors state that HES 130/04 safety for prehospital emergency use remains to be established.
• The authors call for further research to determine whether crystalloid regimens should continue or HES 130/04 can be used safely for prehospital resuscitation.

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