Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial.

Annane D, Siami S, Jaber S, et al.
JAMA 2013;310:1809-1817.
NATA Rating :
Review by : M. Piagnerelli
NATA Review

This new mulitcenter, randomized on the reason for admission (sepsis, trauma, hypovolemia from other causes), but unblinded study compared the effects of crystalloids versus hypo- or hyperoncotic colloids on mortality at day 28 (primary endpoint) and mortality at day 90 and organ failure. While the question is very relevant in daily practice, the very low inclusion rate (< 6 patients per center per year), the rate of deviance, especially in the colloid group (25% of these patients also received crystalloids and they received more fluids - crystalloids - before ICU admission) and study discontinuation due to lack of significant results for the primary endpoint (mortality at day 28) did not allow the authors to conclude. A colloid:crystalloid ratio of 1:1.5 was also found, as in other recent studies on starches. With all of these limits, mortality at day 90 and the number of organ failures appeared to be less with colloids (at a dose < 30 mL/kg body weight/day). There was no difference in the onset of renal failure requiring hemodialysis. Cautiously, the authors conclude that their results could be interesting as a starting point for further studies. – Michael Piagnerelli