Preventing cardiac arrest during hemorrhagic shock with vasopressin.
The optimal strategy of stabilizing hemodynamic function in uncontrolled traumatic hemorrhagic shock states is unclear. Although fluid replacement is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is controversial, because it may worsen bleeding. In the refractory phase of severe hemorrhagic shock, arginine vasopressin has been shown to be beneficial in selected cases due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site toward the heart and brain, and decrease in fluid-resuscitation requirements. Especially in patients with severe traumatic brain injury, rapid stabilization of cardiocirculatory function is essential to ensure adequate brain perfusion, thus, to prevent neurologic damage and to improve outcome. In addition, despite wide distribution of highly developed and professional emergency medical systems in western industrialized countries, survival chances of patients with uncontrolled traumatic hemorrhagic shock in the preclinical setting are still poor.
Raab
Helmut
H
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
Lindner
Karl H
KH
Wenzel
Volker
V
D000818:Animals; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D006259:Craniocerebral Trauma / Q000150:complications; D005440:Fluid Therapy; D006323:Heart Arrest / Q000209:etiology / Q000517:prevention & control*; D006439:Hemodynamics; D006801:Humans; D012771:Shock, Hemorrhagic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin