A narrative review of prehospital hemorrhagic shock treatment with non‐blood product medications

Abstract

Background Hemorrhagic shock remains a leading cause of death in both military and civilian trauma casualties. While standard of care involves blood product administration, maintaining normothermia, and restoring hemostatic function, alternative strategies to treat severe hemorrhage at or near the point of injury are needed. We reviewed adjunct solutions for managing severe hemorrhage in the prehospital environment. Methods We performed a literature review by searching PubMed with a combination of several keywords. Additional pertinent studies were identified by crossreferencing primary articles. Clinical experience of each author was also considered. Results We identified several promising antishock therapies that can be utilized in the prehospital setting: ethinyl estradiol sulfate (EES), polyethylene glycol 20,000 (PEG20K), C1 esterase inhibitors (e.g. Berinert, Cinryze), cyclosporin A, niacin, bortezomib, rosiglitazone, icatibant, diazoxide, and valproic acid (VPA). Conclusion Several studies show promising adjunct treatment options in the management of severe prehospital hemorrhage. While some are rarely used, many others are readily available and commonly utilized for other indications. This suggests the potential for future use in resourcelimited settings. Human studies and case reports supporting their use are currently lacking.

Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis

“…24,25 In addition, the on-going development of potential anti-shock therapies would be highly advantageous as early critical models suggest that such therapies may reduce the amount of blood product necessary, or allow for delays to occur without increased risk mortality. 26 A recent publication by Gurney et al presented findings indicating a definitive blood transfusion futility thresholda point beyond which additional transfusions would not confer any further survival benefits to the patienthas not been established in guiding decisions to terminate transfusion efforts. 7 This essentially means that the threshold, which is typically used to gauge the point at which continuing transfusion becomes futile, was found to be lacking in predictive power when it comes to determining intention to cease transfusion efforts.…”

OMX: A Novel Oxygen Delivery Biotherapeutic Improves Outcomes in an Ovine Model of Controlled Hemorrhagic Shock

“…Hemorrhagic shock remains a major source of morbidity and mortality on and off the battlefield (1)(2)(3)(4)(5). Among battlefield casualties, hemorrhage represents the leading cause of potentially preventable deaths occurring before a medical treatment facility is reached.…”

“…Thus, the mainstay of initial therapy for hemorrhagic shock is to restore adequate oxygen delivery at the tissue level, particularly in critical organs such as the heart, with volume and blood to replenish preload and O 2 content (6). While whole blood or blood product transfusion, along with administration of hemostatic agents such as tranexamic acid, are first-line treatments in this setting, maintaining robust supplies of blood products in austere settings presents significant logistical challenges (1,2,7). Thus, the development of alternate resuscitation measures to augment oxygen delivery, particularly for administration prior to arrival at a medical facility, has been a major area of investigation.…”