Effect of Early Vasopressin Administration in Refractory Hemorrhagic Shock

Hemorrhagic shock management includes controlling bleeding and blood product replacement; however, vasopressor therapy may be required to maintain adequate perfusion. Studies have shown the potential benefits of early vasopressin use, but there is limited evidence of its clinical utility.

This study aims to evaluate the efficacy of early vasopressin administration in trauma patients with refractory hemorrhagic shock.

This retrospective cohort study included adult trauma patients who received more than one blood product. The primary outcome was 28-day alive and vasopressor-free days. Secondary outcomes included blood product administration, 28-day alive and ventilator-free days, and intensive care unit and hospital length of stay (LOS). Safety outcomes included the incidence of renal replacement therapy, venous thromboembolism, and fluid overload.

Overall, 37 patients were included, with seven (19%) in the vasopressin group and 30 (81%) in the norepinephrine group. The study population included primarily male patients (n = 29, 78%) with blunt injuries (n = 24, 65%) and a median Injury Severity Score of 26 [IQR 17.0-34.0]. There was no difference in the primary outcome between the vasopressin and norepinephrine groups (median 25.5 [IQR 22.7-26.7] vs 26.2 days [IQR 22.7-26.7], p = .985). All secondary and safety outcomes were similar, except that the vasopressin group was associated with a longer hospital LOS (20 [IQR 18-27] vs. 13 days [IQR 8-20], p = .036).

Early vasopressin administration was not associated with a significant difference in 28-day alive and vasopressor-free days. However, this study was limited by its small sample size, and further studies are needed.