Objective: A previous meta-analysis has shown a consistent survival benefit in children with severe malaria receiving human albumin solution (HAS) compared to other resuscitation fluids.HAS is expensive and not readily available in Africa. We examined the safety and efficacy of the fluid resuscitation with two synthetic colloids, Dextran 70 and hydroxyethyl starch to inform future trial design.Design: An open-label randomised controlled, phase II safety and efficacy trial. 23/37 (62%) and 25/39 (64%) respectively (p=0.99). Acidosis resolution and respiratory distress was marginally superior in HES group: 3/39 (8%) remained acidotic at 8 hours versus 10/37 (27%) in Dextran arm (p=0.05). There were 4 deaths (5%), two per arm; including 3 deaths in the coma subgroup (3/39, 8%). No other new adverse event was reported.
Conclusions:Correction of shock by volume expansion with either Dextran or HES in children with severe malaria acidosis is safe with low mortality, including the highest risk cases admitted in coma. Both solutions present an attractive and practical option for consideration in future volume resuscitation trials in severe malaria.3