Vasopressin zur Therapie eines therapierefraktären traumatisch-hämorrhagischen Schocks

Abstract

While fluid management is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is being controversially discussed, because it may worsen bleeding. In the irreversible phase of hemorrhagic shock that was unresponsive to volume replacement, airway management and catecholamines, vasopressin was beneficial due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain and decrease of fluid resuscitation requirements. The purpose of this multicenter, randomized, controlled, international trial is to assess the effects of vasopressin (10 IU IV) vs. saline placebo IV (up to 3 injections at least 5 min apart) in patients with prehospital traumatic hemorrhagic shock that persists despite standard shock treatment. The study will be carried out by helicopter emergency medical service teams in Austria, Germany, Czech Republic, Portugal, the Netherlands and Switzerland. Inclusion criteria are adult trauma patients with presumed traumatic hemorrhagic shock (systolic arterial blood pressure <90 mmHg) that does not respond to the first 10 min of standard shock treatment (endotracheal intubation, fluid resuscitation and use of vasopressors) after arrival of the first emergency physician at the scene. The time window for randomization will close after 30 min of shock treatment. Exclusion criteria are terminal illness, no intravenous access, age <18 years, injury >60 min before randomization, cardiac arrest before randomization, presence of a do-not-resuscitate order, untreated tension pneumothorax, untreated cardiac tamponade, or known pregnancy. Primary study end-point is the hospital admission rate, secondary end-points are hemodynamic variables, fluid resuscitation requirements and hospital discharge rate.

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

“…At present, a multicenter, randomized controlled trial (Vasopressin in Traumatic Hemorrhagic Shock—VITRIS study) is being organized in Europe to evaluate the effects of AVP in prehospital management of hemorrhagic shock [52]. Unfortunately, as of now, we only have the results of retrospective studies on humans.…”

Norepinefrina/vasopresina versus norepinefrina en pacientes politraumatizados con traumatismo craneoencefálico severo

“…El paciente politraumatizado y la reanimación encauzada a mantener la estabilidad hemodinámica ha sido objeto de múltiples estudios orientados a buscar estrategias de reanimación hídrica y vasopresores que mantengan la presión de perfusión, tanto cerebral como de otros órganos vitales. [21][22][23] MATERIAL Y MÉTODOS Previa aprobación del comité de ética se realizó un ensayo clínico no aleatorizado, abierto, de grupos paralelos y no doble ciego (Figura 1).…”

Addition of terlipressin to initial volume resuscitation in a pediatric model of hemorrhagic shock improves hemodynamics and cerebral perfusion

“…It is not, however, free of potential adverse effects [ 8 ]. Regarding clinical practice, the results of the most promising international multicenter study on vasopressin for trauma-related shock, the Vasopressin in Refractory Traumatic Hemorrhagic Shock (VITRIS) study, are yet to be published and should help to shed light on the value of using vasopressors in resuscitation in trauma [ 9 ].…”