NHS should ban use of starch based intravenous fluids, say researchers

BMJ 2013; 346 doi: (Published 27 February 2013) Cite this as: BMJ 2013;346:f1323
  1. Jacqui Wise
  1. 1London

Starch based colloid intravenous fluids may be causing around 250 unnecessary deaths in the United Kingdom every year, a new Cochrane systematic review concludes.1 The study’s authors call on the NHS to ban the use of starch based colloid fluids and instead use safer and cheaper crystalloid fluids.

Starch based colloid fluids are used widely in the NHS in the fluid resuscitation of critically ill patients after trauma, burns, or surgery. However, they are more expensive than saline based crystalloid intravenous fluids, and the study authors say it is hard to see how their continuing use in clinical practice could be justified.

The safety and relative effectiveness of colloids and crystalloids have been debated for many years. This new Cochrane review is an updated version of a systematic review first published in the BMJ in 1998.2

Just last week JAMA published a meta-analysis showing the effect of excluding trials conducted by an investigator whose research into hydroxyethyl starch had been retracted because of scientific misconduct.3 Once these trials were excluded, mortality was shown to be higher among patients who had been given hydroxyethyl starch.

Researchers from the London School of Hygiene and Tropical Medicine identified 25 randomised controlled trials that compared hydroxyethyl starch with crystalloids and that included 9147 seriously ill patients. Patients receiving the starch based colloids were 10% more likely than other patients to die rather than be resuscitated.

The study’s lead author, Ian Roberts, director of the clinical trials unit at the London School of Hygiene and Tropical Medicine, said, “Starch solutions are widely used in the NHS, and the evidence from our study shows that they kill patients. They are more expensive than saline and they increase the risk of death. British hospitals use far more starch solutions than most other countries. The ongoing use of colloids is unjustified.”

The European Medicines Agency is currently reviewing the safety of hydroxyethyl starch in critically ill patients. Roberts has written to the Department of Health for England calling on it to act now rather than wait for the review results.

He said, “We don’t need to wait for starch solutions to be banned in order to take action in the NHS. We have a safer, less expensive alternative that is widely used around the world. The NHS should take action now.”


Cite this as: BMJ 2013;346:f1323