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Vasopressor use during emergency trauma surgery.

Robert M Van Haren1, Chad M Thorson, Evan J Valle

  • 1Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida, USA.

The American Surgeon
|June 3, 2014
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Summary
This summary is machine-generated.

Vasopressor use during emergency surgery after trauma is common and linked to higher mortality. However, excluding epinephrine, vasopressors are not independently associated with death in these critically injured patients.

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Area of Science:

  • Trauma Surgery
  • Critical Care Medicine
  • Pharmacology

Background:

  • Early vasopressor administration post-trauma is generally linked to increased mortality.
  • Limited research exists on vasopressor impact specifically in trauma patients needing emergency operative intervention.

Purpose of the Study:

  • To investigate the hypothesis that vasopressors are detrimental in trauma patients undergoing emergency surgery.
  • To determine the association between vasopressor use and mortality in this specific patient cohort.

Main Methods:

  • Retrospective review of 746 trauma patients requiring emergency operative intervention from July 2009 to March 2013.
  • Stratification of patients based on vasopressor use (single or multiple agents) versus no vasopressor use.
  • Analysis of patient demographics, injury severity, vital signs, and mortality rates.

Main Results:

  • Vasopressors were used in 30% of patients during emergency surgery; 8% received multiple agents.
  • Patients receiving vasopressors were older, had more severe injuries, poorer vital signs, and higher mortality (P < 0.001).
  • Epinephrine was independently associated with mortality (OR, 6.88; P = 0.001); however, excluding epinephrine, no significant mortality difference was observed between vasopressor users and non-users (5% vs. 6%, P = 0.523).

Conclusions:

  • Vasopressor use is frequent in severely injured trauma patients undergoing emergency surgery and correlates with mortality.
  • Epinephrine is primarily used for cardiac arrest, while other vasopressors aim for vasoconstriction.
  • Except for epinephrine, vasopressors administered during emergency operative intervention do not appear to be independently associated with increased mortality in trauma patients.