Starch safety in resuscitation

The Western Cape Department of Health (WC DoH) has taken a decision to withdraw all intravenous fluids (IVFs) containing hydroxyethyl starch (HES) from hospitals in the Western Cape, with similar action contemplated in the Free State and Gauteng. This was in response to recommendations from: The European Medicines Agency's Pharmacovigilance Risk Assessment Committee (EMA PRAC) that HES IVFs be withdrawn from clinical use. The United Kingdom Medicines and Healthcare Products Regulatory Agency (MHRA) which has issued a recall of all HES IVFs in the UK. The United States Food and Drug Administration which advises that HES IVFs be used with caution in ICU, cardiac surgery and patients with known kidney disease or coagulopathy. Further advice was that HES should be stopped if coagulopathy or renal dysfunction develops, as well as that renal function should be monitored for 90 days after HES administration.http://www.samj.org.zaam2013ay201

Critical Care Society of Southern Africa adult patient blood management guidelines: 2019 Round-table meeting, CCSSA Congress, Durban, 2018

The CCSSA PBM Guidelines have been developed to improve patient blood management in critically ill patients in southern Africa. These consensus recommendations are based on a rigorous process by experts in the field of critical care who are also practicing in South Africa (SA). The process comprised a Delphi process, a round-table meeting (at the CCSSA National Congress, Durban, 2018), and a review of the best available evidence and international guidelines. The guidelines focus on the broader principles of patient blood management and incorporate transfusion medicine (transfusion guidelines), management of anaemia, optimisation of coagulopathy, and administrative and ethical considerations. There are a mix of low-middle and high-income healthcare structures within southern Africa. Blood products are, however, provided by the same notfor- profit non-governmental organisations to both private and public sectors. There are several challenges related to patient blood management in SA due most notably to a high incidence of anaemia, a frequent shortage of blood products, a small donor population, and a healthcare system under financial strain. The rational and equitable use of blood products is important to ensure best care for as many critically ill patients as possible. The summary of the recommendations provides key practice points for the day-to-day management of critically ill patients. A more detailed description of the evidence used to make these recommendations follows in the full clinical guidelines section.http://www.sajcc.org.za/index.php/SAJCCam2021Critical Car