Why did fluid resuscitation increase mortality in African children with shock in the FEAST trial?

17 Jun 2014

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, 404 kb) and the video below.

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