Hetastarch

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pgg

pgg

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Is anyone still using hetastarch solutions? Under what circumstances?

Some of our combat medics / corpsmen still carry it because it's more weight efficient than crystalloid, they don't have blood, and transport to care may be very delayed. Even that's sort of controversial though.

I haven't seen or used it in years. It had fallen out of favor even before the FDA black box warning in 2013. I don't think any of my hospitals even stock it any more. Thought it had gone the way of droperidol, but for a better reason.

I just came across some in my travels and it surprised me.
 
pgg said:
Is anyone still using hetastarch solutions? Under what circumstances?

Some of our combat medics / corpsmen still carry it because it's more weight efficient than crystalloid, they don't have blood, and transport to care may be very delayed. Even that's sort of controversial though.

I haven't seen or used it in years. It had fallen out of favor even before the FDA black box warning in 2013. I don't think any of my hospitals even stock it any more. Thought it had gone the way of droperidol, but for a better reason.

I just came across some in my travels and it surprised me.
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It's possible I'm wrong, but I believe that they should not be carrying it anymore. Maybe unit dependent? I remember carrying it in my aid bag back in 05' and 08'. But from my understanding from going to c4, we've "replaced" this with the medics now carrying txa to be started in the field and regular ole IV fluids, NS or LR.
 
MirrorTodd said:
It's possible I'm wrong, but I believe that they should not be carrying it anymore. Maybe unit dependent? I remember carrying it in my aid bag back in 05' and 08'. But from my understanding from going to c4, we've "replaced" this with the medics now carrying txa to be started in the field and regular ole IV fluids, NS or LR.
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Could be? I haven't been near a line unit in years. Someone I'm with (who just went to C4 a couple months ago) told me they were still carrying it.
 
I can't remember if he was a ranger or a seal, but one of the mil guys who rotated with us a couple months ago told me they were carrying 3% for volume expansion nowadays...


We don't have any starches at my current shop, but in training we still occasionally used voluven (tetrastarch) for non trauma GDT.
 
I’m shocked it’s still being made - it disappeared overnight when I was a med student.

Just before I finished residency they hired an old vascular surgeon who would regularly ask for hetastarch (when he saw you giving crystalloid or albumin for resusc) and was a real dick when he was told repeatedly it wasn’t in the hospital anymore.
 
I didn't take the time to review the MAR, but at a medium-sized community hospital the surgeon told me hetastarch was being used by the anesthesiologist for resuscitation in the OR before the patient arrived in the ICU.
I asked the surgeon if he really meant hetastarch (?or albumin). The surgeon confirmed hetastarch.
This thread makes me want to see if it's actually available next time I go back to work.
HH
 
Went out about the same time as aprotinin. For not dissimilar reasons. Both seemed pretty handy at the time.
 
We still have it at our institution, and we have an attending who gives ridiculous quantities of precedex (I've seen 3-4mcg/kg total over a spine case) and loads with hetastarch claiming that it works better than albumin for volume expansion to offset the hypotension. Not sure there's any literature support for that, but it's worked well enough for them to continue doing it on the regular.
 
shepardsun said:
We still have it at our institution, and we have an attending who gives ridiculous quantities of precedex (I've seen 3-4mcg/kg total over a spine case) and loads with hetastarch claiming that it works better than albumin for volume expansion to offset the hypotension. Not sure there's any literature support for that, but it's worked well enough for them to continue doing it on the regular.
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eikenhein said:
people still use this stuff????
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I'm seeing it used routinely where I'm at now, a state run hospital in a developing country. Out of roughly 40-60 cases per day, I'd guess about 1/4 or 1/3 get some starch.

E.g. -

Routine scheduled c section: spinal in, 500 ml starch in, switch to NS, baby out, hang a bag of D10.

Post induction hypotension: hang a bag of starch

What's especially odd about it is that most of the suboptimal or non-evidence-based things they do at least have a cost saving rationale behind them. But these fluids cost quite a bit more than LR or NS.
 
I'm pretty sure we don't have it. We have tetrastarch (Voluven). To my understanding, tetrastarch is an improvement over hetastarch, but albumin is by far the preferred colloid at my institution.
 
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