Saline Reduces Mortality for Brain Injury Patients

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"Albumin is a very expensive product that has to be purified," explained Dr. Keith Siller, medical director of the Comprehensive Stroke Care Center at New York University Medical Center in New York City. "If they're equally effective, you'd pick the cheaper fluid."

And, in fact, a previous study had compared the two fluids and found no statistically significant difference in the rates of death after 28 days.

But, Myburgh and his colleagues re-analyzed the original data to assess results at 24 months after injury. In the original study, 460 people with traumatic brain injuries were randomly selected to receive either saline or albumin fluid. Slightly more than two-thirds of the participants in each group were classified as having a severe traumatic brain injury.

After two years, the researchers behind the new study found that people with traumatic brain injuries who received albumin had a 63 percent higher risk of dying than those given saline. For those with severe brain injuries, the albumin group had an 88 percent increased risk of death compared to the saline group.

"These are people in very bad shape," said Siller. "If there's anything that can help them have better outcomes, we have to pay attention."

Dr. James Goodrich, director of pediatric neurosurgery at the Children's Hospital at Montefiore in New York City, said, "This is a great study that definitely found a significant difference in the sense of outcomes." But, he added, it just confirms what's already going on in the treatment of people with serious brain injury. "Albumin has pretty much been given up on," he said.

As to why saline might offer some benefit over albumin, Myburgh said the researchers can't explain the difference. "The exact mechanism by which the difference in mortality between saline and albumin remains unclear," he said.

"It's probably one of two things," said Siller. "Either albumin is making the brain swelling worse, or somehow the saline is doing something beneficial that albumin can't."

More information

To learn more about traumatic brain injury, visit the National Institute of Neurological Disorders and Stroke.