Wednesday, December 11, 2019

Vasopressin for Acute Hemorrhage

R.E.B.E.L.EM - December 09, 2019 - By Rob Bryant
"The AVERT-Shock trial: This was a single center Randomized Clinical Trial examining the effects of Low Dose Vasopressin (LDV) on the early resuscitation of patients with trauma and hemorrhagic shock...
Clinical Bottom Line:
  • The use of Vasopressin as an effective adjunct to the resuscitation of hemorrhagic shock is physiologically plausible
  • The optimal dose and timing of LDV administration is still not clear based off this one single center study.
  • The AVERT-Shock trial demonstrates that the use of Low Dose Vasopressin (LDV) in hemorrhagic shock was not associated with complications or increased mortality. However, AVERT-Shock was underpowered to detect a number of clinically significant secondary outcomes. Larger studies are needed to determine the effect of LDV on these outcomes.
  • In a level one trauma center with access to a massive transfusion protocol, the addition of low dose vasopressin to a patient with continued hypotension despite aggressive administration of blood products is reasonable.
  • The AVERT-Shock trial does not inform our practice in resource limited environments that do not have access to massive transfusion. There is no data currently available to show any benefit / harm of using Vasopressin earlier in the resuscitation of trauma patients prior to resuscitation with blood products."