Hydroxyethyl Starch (HES)

[Jack Ryan]

IV fluids used by NHS responsible for unnecessary deaths

London School of Hygiene & Tropical Medicine, 28 February 2013

Starch-based intravenous (IV) fluids used by the NHS to treat seriously ill patients are causing unnecessary deaths, according to a new Cochrane systematic review by researchers at the School.

Based on data from 25 randomised control trials, the researchers concluded that starch-based colloid fluids, used to stabilise patients with low blood pressure, are not only more expensive than saline-based crystalloid fluids, but may also be causing around 250 unnecessary deaths in the UK every year.

The safety of using colloids containing hydroxyethyl starch has been debated for years. They are widely used to treat shock following severe blood loss by increasing blood volume but recent large high quality studies have linked starch use to renal failure. The trials also found more adverse reactions with starch. Crystalloids work in the same way but do not contain starch.

Calculation for number of deaths: 
Number of adult admissions to NHS critical care units each year = 115,674
Number of patients receiving fluid resuscitation = 42,799
Number of patients receiving colloid = 32,099
Number of patients receiving starch = 12,840
RR of death with STARCH=1.10
Risk of death in unexposed is 20%
For every 50 patients treated there is one extra death
Therefore starch use in British hospitals kill about 12840/50 = 257 patients each year.

https://www.lshtm.ac.uk/newsevents/news/2013/colloid_use_news.html

Hydroxyethyl starch (HES) products were initially withdrawn by NHS on 27 June 2013
https://www.gov.uk/drug-device-alerts/drug-alert-hydroxyethyl-starch-hes-products-increased-risk-of-renal-dysfunction-and-mortality

but reinstated in 2014 in the UK (dec 2013 in Europe) provided that certain precautions were taken - that HES not be used for burn patients, those who have sepsis, those with kidney problems and some others. 

https://www.gov.uk/drug-safety-update/hydroxyethyl-starch-intravenous-infusions