Hemaccel Clinical Indications
Hemaccel (a gelatin-based colloid solution, not hydroxyethyl starch 6%) is traditionally indicated for plasma volume expansion in hypovolemia and shock states, but based on current evidence, crystalloid solutions should be strongly preferred over colloid solutions like Hemaccel for fluid resuscitation in critically ill patients. 1
Important Clarification
The evidence provided discusses hydroxyethyl starch (HES), not Hemaccel specifically. Hemaccel is actually a gelatin-based colloid (polygeline), which is a different class of colloid solution. However, the guideline recommendations apply to both gelatins and HES as colloid solutions.
Current Evidence-Based Recommendations
For Hemorrhagic Shock
Colloid solutions (including gelatins like Hemaccel and HES) are NOT recommended as first-line therapy compared to crystalloids for reducing mortality and renal replacement therapy requirements. 1
- Meta-analyses showed no mortality benefit when comparing HES or gelatins to crystalloid solutions in trauma patients 1
- No difference in renal function was found between colloids (HES, gelatins) and crystalloids in trauma or surgical hemorrhage 1
- Balanced crystalloids are recommended as first-line therapy over both 0.9% NaCl and colloid solutions 1
Key Safety Concerns with Colloid Solutions
The evidence demonstrates several risks:
- Increased renal failure risk: In the FLASH study, renal failure was significantly more frequent with HES [RR 1.34 (1.0–1.8), p = 0.05] 1
- Hemostasis disorders: HES associated with coagulopathy and higher bleeding risk during major surgery 1
- Higher transfusion requirements in ICU settings 1
- No improved prognosis despite better volume expansion capacity (1.5:1 ratio vs crystalloids) 1
Restricted Indications (If Any)
Since 2014, French health authorities (HAS) have restricted colloid use to:
- Second-line treatment only in blood loss situations
- Only when crystalloids are deemed insufficient 1
Even in these restricted scenarios, the evidence does not support improved outcomes with colloids over crystalloids.
Clinical Algorithm
Step 1: For any hypovolemic or shock state → Start with balanced crystalloid solutions (not 0.9% NaCl)
Step 2: If massive ongoing hemorrhage with inadequate response to crystalloids → Consider blood products (packed RBCs, plasma, platelets) rather than colloids
Step 3: Colloids like Hemaccel may only be considered if:
- Crystalloids have been administered in adequate volumes
- Blood products are unavailable or inappropriate
- Patient requires temporary plasma volume expansion
- Acknowledge this carries risks without proven mortality benefit
Common Pitfalls to Avoid
- Do not use colloids as first-line therapy in hemorrhagic shock, septic shock, or perioperative fluid management
- Do not assume volume expansion capacity equals better outcomes - despite colloids expanding volume 1.5x more than crystalloids, this does not translate to improved mortality 1
- Monitor renal function closely if colloids are used, as renal injury risk is documented
- Avoid in septic patients - evidence is particularly strong against colloid use in sepsis
Bottom Line
While Hemaccel may still be marketed in India for plasma volume expansion in hypovolemia, shock, burns, and surgical blood loss, current high-quality guidelines strongly recommend against routine colloid use in favor of balanced crystalloid solutions for all forms of shock and hypovolemia based on mortality, renal outcomes, and safety profile. 1