The importance of resuscitation for surviving critical illness and injury has long been recognized and is now a standard and integral part of critical care practice. Our approach to resuscitation has evolved over the past century, encouraged by intense research efforts that have led to clinical trials of alternative resuscitation fluids including hydroxyethyl starch (HES). One of the key understudied aspects of resuscitation is its effect on the duration of illness or injury in relation to the costs of care. It is estimated that each year, 20 to 30 million patients worldwide will receive resuscitation as part of their care. For an integral aspect of commonly delivered care, there is considerable variation in clinical practice regarding the choice of fluid, in part influenced by product availability, local preferences, and costs.