Vasopressin in Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Randomized Animal Trials

Abstract

Objective. The latest European guidelines for the management of hemorrhagic shock suggest the use of vasopressors (norepinephrine) in order to restore an adequate mean arterial pressure when fluid resuscitation therapy fails to restore blood pressure. The administration of arginine vasopressin (AVP), or its analogue terlipressin, has been proposed as an alternative treatment in the early stages of hypovolemic shock. Design. A meta-analysis of randomized controlled animal trials. Participants. A total of 433 animals from 15 studies were included. Interventions. The ability of AVP and terlipressin to reduce mortality when compared with fluid resuscitation therapy, other vasopressors (norepinephrine or epinephrine), or placebo was investigated. Measurements and Main Results. Pooled estimates showed that AVP and terlipressin consistently and significantly improve survival in hemorrhagic shock (mortality: 26/174 (15%) in the AVP group versus 164/259 (63%) in the control arms; OR = 0.09; 95% CI 0.05 to 0.15; P for effect < 0.001; P for heterogeneity = 0.30; I 2 = 14%). Conclusions. Results suggest that AVP and terlipressin improve survival in the early phases of animal models of hemorrhagic shock. Vasopressin seems to be more effective than all other treatments, including other vasopressor drugs. These results need to be confirmed by human clinical trials.

Pharmacological targeting of chemokine (C-X-C motif) receptor 4 in porcine polytrauma and hemorrhage models

“…3 The current treatment of hemorrhagic shock is limited to fluid resuscitation, surgical/interventional bleeding control, and blood component substitution once the patient arrives in the hospital. Although pressure-support resuscitation of hemorrhagic shock has been discussed as a possible strategy to improve outcomes, 4–6 drugs that increase shock tolerance, stabilize cardiovascular function, and prolong survival are currently not available.…”

Vasopressin‐induced changes in splanchnic blood flow and hepatic and portal venous pressures in liver resection

“…The question then arises whether the intra-operative use of vasopressin may also decrease blood loss in patients without portal hypertension undergoing liver resection surgery for metastases. 22,23 We have previously shown that intraoperative nitroglycerine infusion effectively lowers the portal, hepatic and central venous pressures. On the other hand, if the major determinant of bleeding in liver resection surgery is the filling volume of the intra-hepatic capacitance vessels and/or transhepatic blood flow, then vasopressin could potentially decrease bleeding.…”

Infrarenal aortic clamp reviving a patient from acute surgical haemorrhagic shock: a novel management technique

“…During the early phase of haemorrhagic shock, BP is maintained by sympathetic activation, leading to arterial and compensatory venous vasoconstriction 6 7. When a large amount of blood is lost, this mechanism becomes less effective, leading to vasoplegia of organs.…”

“…Vasopressin inhibits vasodilator mechanisms that contribute to hypotension and vascular hyporeactivity in the late phase of haemorrhagic shock. There is no recommended ceiling dose of vasopressin in humans 7. But typically doses did not exceed 2–4 U/hour to counter vasodilatory shock.…”