CHI’s knowledge Synthesis Team led a systematic review and meta-analysis evaluating the use of hydroxyethyl starch (HES) in critically ill patients, and found “clear and irrefutable evidence that hydroxyethyl starch was causing death.” A paper resulting from the study was published in the Journal of the American Medical Association (JAMA) and received media attention from around the world. The paper resulted in changes in practice in North America, the European Union, Great Britain and South Africa.