Vasopressin in traumatic hemorrhagic shock

Hemorrhage and subsequent development of therapy refractory shock are the major cause of death in potentially salvageable trauma victims. Recent scientific work recognizes that there is an urgent need to develop new life-support strategies. From a variety of interventions and drugs with the potential to prolong the compensation phase or to reverse the decompensation phase of shock, arginine vasopressin (AVP) is one of the most promising and best evaluated drugs. Nonetheless, the efficacy of AVP administration in hemorrhagic shock is still to be proven. Thus, this umbrella review summarizes the current evidence of AVP in hemorrhagic shock.

Fifteen short reviews, narrative reviews, systematic reviews and meta-analysis addressing AVP in traumatic hemorrhagic shock were identified and included in this umbrella review. There is robust evidence deriving form 23 animal studies that AVP administration is effective in hemorrhagic shock, resulting in hemodynamic stabilization and improved survival. This observation is supported by six case reports but not confirmed by two retrospective observational studies and two randomized control trials.

In uncontrolled hemorrhagic shock, arginine vasopressin might be considered as a therapy of last resort in shock patients not responding to conventional therapy. Further research is needed to determine the potential benefits and optimal dosage/timing of vasopressin use in hemorrhagic shock.