Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for most outcomes.
Population: People with a range of diagnoses (most commonly trauma, sepsis, septic shock, hypovolemia, hemorrhagic shock, burns) requiring fluid volume resuscitation
Intervention: Colloids (starches; dextrans; gelatins; albumin or fresh frozen plasma) ᵃ
Comparison: Crystalloids
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Starch solution versus crystalloids ᵃ | ||
Mortality: at the end of follow-up ᵇ | No statistically significant difference | Moderate |
Transfusion of blood product | Favors comparison | Moderate |
Renal replacement therapy | Favors comparison | Moderate |
Adverse events: allergic reaction | No statistically significant difference | Very Low |
Adverse events: itching | Occurs more commonly with starch compared with crystalloids (favors comparison) | Very Low |
Adverse events: rash | No statistically significant difference | Very Low |
Dextrans versus crystalloids | ||
Mortality: at the end of follow-up ᵇ | No statistically significant difference | Moderate |
Transfusion of blood products | No statistically significant difference | Very Low |
Adverse events: allergic reaction | No statistically significant difference | Moderate |
Renal replacement therapy | - | None of the studies identified by the review assessed this outcome |
Gelatins versus crystalloids | ||
Mortality: at the end of follow-up ᶜ | No statistically significant difference | Low |
Transfusion of blood product | No statistically significant difference | Very Low |
Adverse events | No statistically significant difference | Very Low |
Renal replacement therapy | - | See note ᵈ |
Albumin or fresh frozen plasma versus crystalloids | ||
Mortality: at the end of follow-up ᵇ | No statistically significant difference | Moderate |
Transfusion of blood product | No statistically significant difference | Very Low |
Renal replacement therapy | No statistically significant difference | Low |
Adverse events (allergic reactions) | No statistically significant difference | Very Low |
Note ᵃ Important information post publication of the Cochrane Clinical Answer (CCA): In July 2021, the US Food and Drug Administration (FDA) issued safety labeling changes for solutions containing hydroxyethyl starch (HES) stating that HES products should not be used unless adequate alternative treatment is unavailable.[74] The Pharmacovigilance Risk Assessment Committee of the European Medicines Agency in February 2022 recommended suspending HES solutions for infusion.[75] ᵇ The CCA also reports mortality within 30 days and 90 days as a subgroup analysis; moderate-quality evidence also reported no statistically significant difference between treatment groups. ᶜ Low-quality evidence also reported no statistically significant difference between gelatins and crystalloids for mortality within 30 days and within 90 days. ᵈ The reviewers of the main Cochrane review which this CCA is based on found one RCT which assessed the effectiveness of colloids for this outcome, but gelatins were not reported separately.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- How do colloids compare with crystalloids for fluid resuscitation in critically ill people?
- In people with myocardial infarction complicated by cardiogenic shock, what are the effects of intra-aortic balloon pump counterpulsation (IABP)?
Use of this content is subject to our disclaimer