The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma.

Background: When resuscitating patients with hemorrhagic shock following trauma, fluid volume restriction and permissive hypotension prior to bleeding control are emphasized along with the good outcome especially for penetrating trauma patients. However, evidence that these concepts apply well to the management of blunt trauma is lacking, and their use in blunt trauma remains controversial. This study aimed to assess the impact of vasopressor use in patients with blunt trauma in severe hemorrhagic shock.

Methods: In this single-center retrospective study, we reviewed records of blunt trauma patients with hemorrhagic shock and included patients with a probability of survival < 0.6. Vital signs on arrival, characteristics, examinations, concomitant injuries and severity, vasopressor use and dose, and volumes of crystalloids and blood infused were compared between survivors and non-survivors. Data are described as median (25-75% interquartile range) or number.

Results: Forty patients admitted from April 2014 to September 2019 were included. Median Injury Severity Score in survivors vs non-survivors was 41 (36-48) vs 45 (34-51) (p = 0.48), with no significant difference in probability of survival between the two groups (0.22 [0.12-0.48] vs 0.21 [0.08-0.46]; p = 0.93). Despite no significant difference in patient characteristics and injury severity, non-survivors were administered vasopressors significantly earlier after admission and at significantly higher doses. Total blood transfusion amount administered within 24 h after admission was significantly higher in survivors (8430 [5680-9320] vs 6540 [4550-7880] mL; p = 0.03). Max catecholamine index was significantly higher in non-survivors (2 [0-4] vs 14 [10-18]; p = 0.008), and administered vasopressors were terminated significantly earlier (12 [4-26] vs 34 [10-74] hours; p = 0.026) in survivors. Although the variables of severity of the patients had no significant differences, vasopressor use (Odds ratio [OR] = 21.32, 95% confident interval [CI]: 3.71-121.6; p = 0.0001) and its early administration (OR = 10.56, 95%CI: 1.90-58.5; p = 0.005) indicated significant higher risk of death in this study.

Conclusion: Vasopressor administration and high-dose use for resuscitation of hemorrhagic shock following severe blunt trauma are potentially associated with increased mortality. Although the transfused volume of blood products tends to be increased when resuscitating these patients, early termination of vasopressor had better to be considered.