Why did fluid resuscitation increase mortality in
African children with shock in the FEAST trial?
11 May 2012
Detailed analysis of data from the FEAST
trial has revealed that the higher rates of death among
children given rapid fluid resuscitation seem to be because of
cardiovascular collapse rather than fluid overload. The FEAST trial
found that giving fluids rapidly through a drip into a vein (fluid
resuscitation) as an emergency treatment for African children
suffering with shock from severe infections actually increased
death rates. These findings, which were published last year, were
surprising, as fluid resuscitation is standard practice for
children in shock in high-income countries. Researchers from the
FEAST trial have carried out further detailed analysis of the data
to try to work out why they had these unexpected results. This
further analysis was presented yesterday at the European Society
for Paediatric Infectious Diseases.
The new results showed that fluid resuscitation increased death
rates in all the subgroups examined in the trial (such as what
symptoms the children had, whether or not they had anaemia, and
which definition of shock was used). Fluid resuscitation initially
helped to restore normal circulation compared to no bolus controls,
but this did not lead to improved survival. Fluid resuscitation
seemed to be most harmful to those children with the most severe
shock and severe acidosis. The excess deaths seemed to be more due
to cardiovascular collapse than fluid overload, which is surprising
as fluid overload was considered to be the main risk of fluid
resuscitation. These results question the speed and volume of
fluids used for treating children in shock due to infectious
diseases in Africa.
The trial did not look at children with shock due to diarrhoea
and other conditions like burns and trauma, where children lose
fluids. For these conditions fluid resuscitation will continue to
be a vital life-saving treatment. Children with severe malnutrition
were not included in the trial as fluids are not recommended as
part of their treatment.
More information about the FEAST trial and its findings can be
found in this policy brief (pdf,
406kb) and the video below.