title: 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.
  
  
  METHODS
  A meta-analysis of randomized controlled animal trials.
  
  
  METHODS
  A total of 433 animals from 15 studies were included.
  
  
  METHODS
  The ability of AVP and terlipressin to reduce mortality when compared with fluid resuscitation therapy, other vasopressors (norepinephrine or epinephrine), or placebo was investigated.
  
  
  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; I2=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.
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, SS.554 Bivio per Sestu, 09042 Monserrato, Italy.
authors.forename: Andrea Pasquale
authors.initials: AP
authors.lastname: Cossu
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, SS.554 Bivio per Sestu, 09042 Monserrato, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mura
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, SS.554 Bivio per Sestu, 09042 Monserrato, Italy.
authors.forename: Lorenzo Matteo
authors.initials: LM
authors.lastname: De Giudici
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, SS.554 Bivio per Sestu, 09042 Monserrato, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Puddu
authors.affiliation: Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milano, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.affiliation: Department of Anesthesia and Intensive Care, Catholic University, Via Giuseppe Moscati 31, 00198 Roma, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Evangelista
authors.affiliation: MSc Program "Cardiopulmonary Resuscitation", University of Athens, Medical School, Hellenic Society of Cardiopulmonary Resuscitation, 75 Mikras Asias Street, 11527 Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, SS.554 Bivio per Sestu, 09042 Monserrato, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Musu
authors.affiliation: Department of Medical Sciences "M. Aresu", University of Cagliari, SS.554 Bivio per Sestu, 09042 Monserrato, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Finco
mesh_terms: D000818:Animals; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009638:Norepinephrine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012769:Shock / Q000188:drug therapy / Q000473:pathology; D012771:Shock, Hemorrhagic / Q000188:drug therapy* / Q000473:pathology; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D008236:Lypressin; D000077585:Terlipressin; D009638:Norepinephrine