Related Experiment Video
Updated: Jul 11, 2025
Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine
Published on: August 24, 2018
Prostacyclin in trauma patients with hemorrhagic shock: A randomized clinical trial
Pär I Johansson1, Christian Fenger Eriksen, Pernille E Bovbjerg
1From the CAG Center for Endotheliomics (P.I.J.), Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (P.I.J.), University of Copenhagen, Copenhagen; Department of Anesthesiology (C.F.E., M.S.A.), Aarhus University Hospital, Aarhus; Department of Orthopedic Surgery (P.E.B.), Odense University Hospital, Odense, Denmark; Department of Traumatology (C.G., P.A.N.), Oslo University Hospital; Institute of Clinical Medicine (C.G., P.A.N.), University of Oslo, Oslo, Norway; Department of Anesthesiology (M.P.) and Intensive Care V (M.P.), Odense University Hospital, Odense; CAG Center for Endotheliomics (H.H.H., K.H.P., M.V.), Copenhagen University Hospital-Rigshospitalet; Section of Biostatistics (T.L.), University of Copenhagen, Copenhagen; Research Center for Emergency Medicine (H.K.), Aarhus University Hospital; Aarhus University (H.K.), Aarhus; and CAG Center for Endotheliomics (J.S.), and Department of Anesthesiology (J.S.), Department of Anesthesiology, Centre of Head and Orthopedics (J.S.), Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Background:
A main cause of trauma morbidity and mortality is multiple-organ failure, and endotheliopathy has been implicated. Pilot studies indicate that low-dose prostacyclin improves endothelial functionality in critically ill patients, suggesting that this intervention may improve trauma patient outcome.
Methods:
We conducted a multicenter, randomized, blinded, clinical investigator-initiated trial in 229 trauma patients with hemorrhagic shock who were randomized 1:1 to 72 hours infusion of the prostacyclin analog iloprost (1 ng/kg/min) or placebo. The primary outcome was the number of intensive care unit (ICU)-free days alive within 28 days of admission. Secondary outcomes included 28-day all-cause mortality and hospital length of stay.
Results:
The mean number of ICU-free days alive within 28 days was 15.64 days in the iloprost group versus 13.99 days in the placebo group (adjusted mean difference, -1.63 days [95% confidence interval (CI), -4.64 to 1.38 days]; p = 0.28). The 28-day mortality was 18.8% in the iloprost group versus 19.6% in the placebo group (odds ratio, 1.01 [95% CI, 0.51-2.0]; p = 0.97). The mean hospital length of stay was 19.96 days in the iloprost group versus 27.32 days in the placebo group (adjusted mean difference, 7.84 days [95% CI, 1.66-14.02 days], p = 0.01).
Conclusion:
Iloprost did not result in a statistically significant increase in the number of ICU-free days alive within 28 days of admission, whereas it was safe and a statistically significant reduction in hospital length of stay was observed. Further research on prostacyclin in shocked trauma patients is warranted.
Level Of Evidence:
Therapeutic/Care Management; Level II.
Related Concept Videos
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care
01:05Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...