Vasopressin improves survival in a porcine model of abdominal vascular injury.
BACKGROUND
We sought to determine and compare the effects of vasopressin, fluid resuscitation and saline placebo on haemodynamic variables and short-term survival in an abdominal vascular injury model with uncontrolled haemorrhagic shock in pigs.


METHODS
During general anaesthesia, a midline laparotomy was performed on 19 domestic pigs, followed by an incision (width about 5 cm and depth 0.5 cm) across the mesenterial shaft. When mean arterial blood pressure was below 20 mmHg, and heart rate had declined progressively, experimental therapy was initiated. At that point, animals were randomly assigned to receive vasopressin (0.4 U/kg; n = 7), fluid resuscitation (25 ml/kg lactated Ringer's and 25 ml/kg 3% gelatine solution; n = 7), or a single injection of saline placebo (n = 5). Vasopressin-treated animals were then given a continuous infusion of 0.08 U/kg per min vasopressin, whereas the remaining two groups received saline placebo at an equal rate of infusion. After 30 min of experimental therapy bleeding was controlled by surgical intervention, and further fluid resuscitation was performed. Thereafter, the animals were observed for an additional hour.


RESULTS
After 68 +/- 19 min (mean +/- standard deviation) of uncontrolled bleeding, experimental therapy was initiated; at that time total blood loss and mean arterial blood pressure were similar between groups (not significant). Mean arterial blood pressure increased in both vasopressin-treated and fluid-resuscitated animals from about 15 mmHg to about 55 mmHg within 5 min, but afterward it decreased more rapidly in the fluid resuscitation group; mean arterial blood pressure in the placebo group never increased. Seven out of seven vasopressin-treated animals survived, whereas six out of seven fluid-resuscitated and five out of five placebo pigs died before surgical intervention was initiated (P < 0.0001).


CONCLUSIONS
Vasopressin, but not fluid resuscitation or saline placebo, ensured short-term survival in this vascular injury model with uncontrolled haemorrhagic shock in sedated pigs.
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse, 6020 Innsbruck, Austria. karl-heinz.stadlbauer@i-med.ac.at
Karl H
KH
Stadlbauer
Horst G
HG
Wagner-Berger
Anette C
AC
Krismer
Wolfgang G
WG
Voelckel
Alfred
A
Konigsrainer
Karl H
KH
Lindner
Volker
V
Wenzel
D000007:Abdominal Injuries / Q000150:complications / Q000188:drug therapy*; D000818:Animals; D004195:Disease Models, Animal; D005440:Fluid Therapy; D006490:Hemostatics / Q000627:therapeutic use*; D008643:Mesentery / Q000293:injuries; D011897:Random Allocation; D012771:Shock, Hemorrhagic / Q000188:drug therapy* / Q000209:etiology; D012965:Sodium Chloride / Q000627:therapeutic use; D034421:Sus scrofa; D016896:Treatment Outcome; D014667:Vasopressins / Q000627:therapeutic use*
D006490:Hemostatics; D014667:Vasopressins; D012965:Sodium Chloride