RescueFlow: Uses, Dosage & Side Effects

What Is RescueFlow and What Is It Used For?

RescueFlow belongs to a class of medicines known as hypertonic colloid solutions or more specifically hypertonic saline-dextran (HSD) solutions. Unlike standard isotonic crystalloids (such as 0.9% sodium chloride or lactated Ringer’s), which have the same tonicity as blood and therefore need to be given in large volumes to achieve circulatory effect, RescueFlow is strongly hypertonic: its sodium concentration is roughly eight times that of normal plasma. This steep osmotic gradient is the foundation of its therapeutic effect.

The primary clinical indication for RescueFlow is the initial treatment of hypovolemic shock. Hypovolemic shock is a life-threatening condition in which the volume of blood or other fluids circulating through the body drops so much that the heart can no longer deliver enough oxygen to vital organs. It most often arises from major trauma with internal or external hemorrhage (hemorrhagic shock), penetrating injuries, vascular rupture (for example, from an abdominal aortic aneurysm), gastrointestinal bleeding, severe burns, or massive fluid loss from vomiting, diarrhea, or surgery. Early and effective volume resuscitation during the first minutes of shock is one of the most important determinants of survival in trauma medicine.

In these scenarios, logistics often matter as much as pharmacology. On a helicopter, in an ambulance, on a battlefield, or in a mass-casualty incident, every kilogram of equipment and every minute of infusion time counts. A standard resuscitation approach with 2–3 liters of isotonic crystalloid is neither practical nor optimal. RescueFlow was developed specifically to address this problem: the 250 ml bag is light, stable, and produces a hemodynamic response comparable to 1–2 liters of isotonic fluid within minutes of administration. This makes it particularly useful in prehospital emergency medicine, combat casualty care, and austere or resource-limited environments.

RescueFlow is not, and should never be used as, a stand-alone treatment for hemorrhagic shock. Modern trauma resuscitation follows a strategy known as damage control resuscitation, which emphasizes early hemorrhage control (tourniquets, hemostatic dressings, surgery), permissive hypotension (avoiding over-resuscitation in patients with uncontrolled bleeding), early use of blood products in a balanced 1:1:1 ratio (red cells, plasma, platelets), and correction of coagulopathy. Within this framework, RescueFlow serves as a bridging therapy: a fluid that can sustain perfusion during the minutes or hours it takes to reach a hospital equipped with blood banking, operating theatres, and interventional radiology.

Beyond trauma, RescueFlow has been studied and, in some jurisdictions, indicated for selected scenarios including severe burns (particularly during the resuscitation phase of deep partial-thickness and full-thickness burns covering a large body surface area), intraoperative hypovolemia during major surgery with significant blood loss, and septic shock with profound hypovolemia unresponsive to standard crystalloid therapy. Use outside of the primary hypovolemic shock indication is less well supported by randomized trial data and should follow institutional protocols and expert judgment.

It is important to appreciate that the global evidence base for hypertonic saline-dextran in trauma has evolved over the past three decades. Early observational studies and meta-analyses suggested a mortality benefit, particularly in patients with traumatic brain injury and hemorrhagic shock. However, large randomized controlled trials published in the 2010s – most notably the Resuscitation Outcomes Consortium (ROC) Hypertonic Resuscitation trials – did not demonstrate a survival advantage over isotonic crystalloids in the overall prehospital trauma population. As a result, major guidelines such as the Advanced Trauma Life Support (ATLS) 10th edition no longer recommend HSD as a first-line fluid, and modern European and North American trauma systems increasingly rely on early whole blood or balanced blood-product resuscitation. RescueFlow therefore remains an important option in specific settings – such as prolonged field care, military deployment, or when blood products are not yet available – rather than a routine first-choice fluid.

What Should You Know Before Receiving RescueFlow?

Because RescueFlow is almost always administered in emergency situations where the patient may be unconscious or unable to give a full medical history, the responsibility for screening for contraindications and risk factors falls entirely on the treating clinical team. A rapid but systematic review of the patient’s known medical history, current medications, medical alert bracelets, and clinical signs is essential before the infusion is started.

Contraindications

RescueFlow should not be used in the following circumstances:

• Known hypersensitivity to dextran 70, sodium chloride, or any of the excipients in the formulation. A single previous anaphylactoid reaction to any dextran-containing product is an absolute contraindication.
• Decompensated congestive heart failure or severe left ventricular dysfunction where a rapid increase in preload may precipitate acute pulmonary edema.
• Anuric or severe oliguric renal failure not responsive to fluid challenge, because of the risk of fluid and solute accumulation, particularly of dextran molecules and sodium.
• Severe pre-existing hypernatremia (serum sodium > 160 mmol/l) or hyperchloremic states where additional sodium load would be harmful.
• Dehydration without concurrent shock, where there is no vascular space to safely receive a hypertonic fluid.
• Significant bleeding disorders or known severe coagulopathy, because dextran impairs platelet function and may exacerbate bleeding.
• Uncontrolled intracranial hemorrhage where rapid elevation of blood pressure could worsen the bleeding.

Warnings and Precautions

Several important warnings apply to the use of RescueFlow. The hypertonic saline component can cause a rapid rise in serum sodium concentration, and administration of more than the recommended volume can lead to hypernatremia, hyperchloremic acidosis, and in theory – if the sodium rises too rapidly in a chronically hyponatremic patient – osmotic demyelination syndrome (also known as central pontine myelinolysis). For this reason, RescueFlow is designed for a single 250 ml bag per patient and should not be repeated without careful reassessment and electrolyte monitoring.

The dextran component has well-documented effects on coagulation and platelet function. Dextran 70 coats platelets and reduces their adhesion and aggregation, and may also affect the function of factor VIII and von Willebrand factor. In most patients this effect is clinically negligible, but in patients with uncontrolled bleeding, pre-existing coagulopathy, or on anticoagulant therapy, the combination can worsen hemorrhage. Clinicians must weigh the benefit of rapid volume expansion against the risk of additional bleeding.

RescueFlow should be administered with close monitoring of hemodynamics (blood pressure, heart rate, ideally mean arterial pressure), respiration, oxygen saturation, and, when feasible, serum sodium, chloride, and osmolality. In a hospital setting, arterial blood gases and coagulation parameters should be checked at baseline and after the infusion where resources allow. In the prehospital environment, monitoring is often limited, and the emphasis is on clinical re-evaluation – improved mentation, palpable pulses, reduced capillary refill time, and restoration of radial pulse – to guide further treatment.

Because RescueFlow is a small-volume, fast-acting resuscitation fluid, there is a particular risk of over-resuscitation in patients with uncontrolled hemorrhage. Raising blood pressure too rapidly can dislodge clots and worsen bleeding before surgical control is achieved. The concept of permissive hypotension – targeting a systolic blood pressure of approximately 80–90 mmHg in penetrating trauma prior to hemorrhage control – should therefore guide infusion rate and the decision to administer any further fluid after the initial bolus.

Pregnancy and Breastfeeding

There are only limited controlled clinical data on the use of RescueFlow during pregnancy. The hypertonic saline component has been used safely in pregnant patients with severe hyponatremia, and crystalloid resuscitation is standard in obstetric emergencies. The safety profile of dextran 70 in pregnancy, however, is less well established. In life-threatening hemorrhagic shock – for example, from traumatic injury, placental abruption, or postpartum hemorrhage – the benefit of rapid resuscitation usually outweighs the theoretical fetal risk, and RescueFlow may be used as part of a broader resuscitation strategy that should quickly transition to blood-product therapy.

There is no information on the excretion of dextran 70 or its metabolites in breast milk. However, given the emergency indication and single-dose nature of the product, breastfeeding need not be routinely interrupted after a single administration. Decisions about continued breastfeeding should be made case by case in discussion with the obstetric and pediatric teams.

Driving and Operating Machinery

How Does RescueFlow Interact with Other Drugs?

Drug interactions involving RescueFlow fall into several distinct mechanistic groups. Because the product is administered as a single bolus in an acute setting rather than as chronic therapy, the practical concern is usually whether a patient is already taking drugs that may amplify the side-effect profile of HSD, rather than whether other medicines will be altered by a single RescueFlow infusion.

Major Interactions

Minor Interactions and Laboratory Interference

Besides the pharmacological interactions above, RescueFlow can interfere with several laboratory tests. The dextran component can cause false elevations in serum glucose measured by older methods, interfere with blood typing and cross-matching (rouleaux formation and coating of red cells), and alter erythrocyte sedimentation rate and total protein assays. Blood samples for type-and-cross-match should ideally be drawn before any dextran is infused, and the laboratory should be informed if the patient has received dextran, so that appropriate cross-matching techniques (saline washing of red cells) can be used.

RescueFlow is not pharmaceutically compatible with many other intravenous medications and should generally be administered through a dedicated venous access line. Do not mix RescueFlow with blood products, amino acid solutions, or lipid emulsions in the same infusion line.

What Is the Correct Dosage of RescueFlow?

RescueFlow is dosed very differently from conventional intravenous fluids. Rather than being titrated continuously to clinical response, it is given as a single pre-packaged bolus that takes advantage of a strong osmotic gradient. Dosage, rate, and monitoring parameters are designed around this one-shot mechanism, and repeated or prolonged administration is not appropriate.

Adults

The single-dose strategy reflects two important principles. First, most of the hemodynamic benefit of hypertonic saline is obtained within the first 10–15 minutes of infusion; further boluses increase the sodium load without substantial additional volume benefit. Second, a repeated dose substantially increases the risk of hypernatremia, anaphylactoid reaction, and coagulopathy. For these reasons, RescueFlow is labeled and packaged for single-patient, single-use administration.

Children

Elderly

How RescueFlow Is Administered

RescueFlow is administered by qualified healthcare professionals – emergency physicians, anesthesiologists, intensive care specialists, flight physicians, military medics, or advanced critical-care paramedics – following local protocols. The typical sequence is:

1. Confirm the indication: severe hypovolemic or hemorrhagic shock with a systolic blood pressure below the institutional threshold (often < 90 mmHg in blunt trauma or with evidence of end-organ hypoperfusion) despite initial isotonic crystalloid.
2. Establish large-bore intravenous access (ideally 14–16 gauge) or a central venous catheter in a hospital setting.
3. Inspect the solution for clarity and particulate matter; do not use if the bag is damaged, cloudy, or discolored.
4. Infuse the full 250 ml over 2–5 minutes using a pressure bag or a gravity setup with wide-open clamp, depending on availability.
5. Reassess within 5–10 minutes: check blood pressure, heart rate, mental status, pulse quality, and, if available, lactate and base deficit. Transition to crystalloids and blood products for continued resuscitation.
6. Document the time, rate, and volume administered, the response, any adverse events, and plans for continued resuscitation.

Missed Dose

The concept of a “missed dose” does not apply to RescueFlow because it is a single-use emergency medication rather than a scheduled therapy. If the clinical indication for RescueFlow was not recognized at the scene and the patient arrived at hospital without receiving it, the treating team will reassess whether further hypertonic saline-dextran therapy is appropriate or whether the patient should proceed directly to blood-product resuscitation and definitive care.

Overdose

Overdose of RescueFlow is most likely to occur if more than one 250 ml bag is administered within a short period or if the infusion rate is too rapid. The main consequences are severe hypernatremia, hyperchloremic metabolic acidosis, hypervolemia with pulmonary edema, and worsening coagulopathy. Neurologic effects of acute hypernatremia include confusion, seizures, and in severe cases, coma; chronic hypernatremia corrected too quickly can lead to osmotic demyelination syndrome.

Management of overdose is supportive. The infusion should be stopped immediately. Blood sodium, chloride, osmolality, renal function, and coagulation should be measured. In hypervolemic patients, loop diuretics may be required; in hypernatremic patients, careful rehydration with isotonic and then hypotonic fluids is usually needed, with sodium correction limited to no more than 10–12 mmol/l per 24 hours in chronic cases. Severe dextran-induced coagulopathy may require plasma, platelets, and in extreme cases plasma exchange. Patients with suspected overdose should be managed in an intensive care setting with frequent laboratory reassessment.

What Are the Side Effects of RescueFlow?

Like all medicines, RescueFlow can cause side effects, although not every patient will experience them. Because the fluid is strongly hypertonic and contains a high-molecular-weight colloid, several adverse effects are directly predictable from its physicochemical properties. The frequency categories below follow the standard European Medicines Agency (EMA) convention used in most Summaries of Product Characteristics.

The most clinically important severe reaction is dextran-induced anaphylactoid reaction (DIAR). This typically occurs within the first few minutes of infusion and presents with a combination of urticaria, bronchospasm, hypotension, and, in severe cases, circulatory collapse. Unlike classic IgE-mediated anaphylaxis, DIAR is usually mediated by pre-formed dextran-reactive antibodies of the IgG class that form immune complexes with infused dextran molecules. The risk of severe DIAR has been substantially reduced in modern practice by pretreatment with dextran 1 (hapten dextran), a low-molecular-weight monovalent dextran that binds to pre-formed antibodies and prevents cross-linking. In jurisdictions where dextran 1 is available and its use is recommended, it should be administered according to local product information before RescueFlow.

The coagulopathic effect of dextran is both dose- and time-dependent, but even a single 250 ml dose can produce measurable platelet dysfunction and a modest dilution of clotting factors. In most patients, this has no clinical consequence, but in those with ongoing major hemorrhage or pre-existing coagulopathy it can tip the balance toward worse bleeding. This is one reason why modern damage-control resuscitation prioritizes early blood-product transfusion, which restores both volume and coagulation capacity.

Another specific concern is the risk of hypernatremia and osmotic demyelination. A single adult dose of RescueFlow delivers approximately 321 mmol of sodium in 250 ml, which is comparable to the sodium content of about 2 liters of 0.9% sodium chloride delivered in just a few minutes. In a previously normonatremic shock patient, this produces a brief, clinically tolerated rise in serum sodium. However, if the patient has unsuspected chronic hyponatremia – for example, due to heart failure, liver disease, SIADH, or chronic thiazide therapy – the rapid correction can precipitate osmotic demyelination syndrome, a potentially catastrophic neurological complication. This is one of the reasons that RescueFlow should not be given to patients with a known history of chronic hyponatremia without specialist input.

How Should RescueFlow Be Stored?

Proper storage is important to maintain the sterility, physical stability, and therapeutic effectiveness of RescueFlow. Because the solution contains both a hypertonic electrolyte and a biological polymer (dextran), it is susceptible to crystallization at low temperatures and to degradation of the colloid at high temperatures.

• Temperature: Store below 25 °C (77 °F). Do not freeze. Freezing can cause crystallization of sodium chloride and irreversible changes in the dextran polymer structure. If a bag has been accidentally frozen, it must be discarded even after thawing.
• Light exposure: Keep the bag in the outer carton until use to protect it from direct sunlight and fluorescent light, which can accelerate polymer degradation.
• Packaging integrity: Inspect each bag before use. Do not use if the outer wrap is damaged, the bag is leaking, or the solution is cloudy, discolored, or contains visible particles.
• Expiry date: Do not use after the expiry date (“EXP”) printed on the bag and outer carton. The expiry date refers to the last day of the stated month.
• After opening: RescueFlow is for single use only. Use the solution immediately after the infusion set has been connected. Discard any unused portion and the empty bag according to local pharmaceutical and biohazard waste regulations. Never store a partially used or spiked bag for later administration.
• Transport: When transported for prehospital use in ambulances, helicopters, or military vehicles, ensure that the product is protected from temperature extremes. Stored bags in ambulance lockers should be rotated regularly so that nearly expired products are replaced.

Unused or expired bags of RescueFlow must not be disposed of via domestic waste or flushed into water systems. They must be returned to the hospital pharmacy or dispatched through a licensed pharmaceutical waste carrier for incineration in accordance with local environmental regulations.

What Does RescueFlow Contain?

Understanding the exact composition of RescueFlow is important both for clinical decision-making and for identifying potential allergens or interferents. The formulation is deliberately minimalist: a single electrolyte (sodium chloride) at a supraphysiological concentration combined with a single colloid (dextran 70) in water for injection.

Two physicochemical parameters of RescueFlow are particularly relevant at the bedside. The osmolality is approximately 2,567 mOsm/kg – nearly nine times that of plasma (approximately 290 mOsm/kg). This is the mechanism behind its rapid volume-expanding effect but also the reason why extravasation can cause local tissue injury and why the solution must be administered through a well-functioning, ideally large-bore intravenous line. The colloid osmotic (oncotic) pressure contributed by dextran 70 is roughly comparable to that of human albumin solution, which is what allows the dextran component to retain the mobilized fluid within the vascular compartment for several hours.

Appearance and Packaging

RescueFlow is supplied as a clear, colorless to slightly yellowish sterile solution, packaged in a 250 ml collapsible, non-PVC polymer infusion bag with two sterile ports: one for spiking with the infusion set and one for the addition of compatible medications when clinically required (although co-administration of other drugs is generally discouraged). Each infusion bag is wrapped in a protective outer pouch to maintain sterility and protect from light. Bags are supplied individually or in cartons of 10 for hospital, EMS, and military procurement. Not all pack sizes may be marketed in every country.

RescueFlow is manufactured under strict Good Manufacturing Practice (GMP) standards, and every batch is tested for pH, osmolality, sterility, endotoxin content, dextran molecular weight distribution, and absence of particulate matter. The product is generally supplied to hospital pharmacies and EMS services rather than to individual patients.