Vasopressin, but Not Fluid Resuscitation, Enhances Survival in a Liver Trauma Model with Uncontrolled and Otherwise Lethal Hemorrhagic Shock in Pigs

Stadlbauer, Karl H.; Wagner-Berger, Horst G.; Raedler, Claus; Voelckel, Wolfgang G.; Wenzel, Volker; Krismer, Anette C.; Klima, G.; Rheinberger, Klaus; Nußbaumer, Walter; Pressmar, Daniel; Lindner, Karl H.; Königsrainer, Alfred

doi:10.1097/00000542-200303000-00018

Cited by 104 publications

(51 citation statements)

References 14 publications

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“…We have shown beneficial effects of vasopressin vs. epinephrine in porcine models with hemorrhagic shock (33)(34)(35). In the clinical setting, we observed positive effects of vasopressin in some patients with life-threatening hemorrhagic shock with collapsing arterial blood pressure who did not respond anymore to adrenergic catecholamines and fluid resuscitation.…”

Section: The Futurementioning

confidence: 77%

Vasopressin during cardiopulmonary resuscitation: A progress report

Krismer

Wenzel

Stadlbauer

et al. 2004

Critical Care Medicine

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Section: The Futurementioning

confidence: 77%

Vasopressin during cardiopulmonary resuscitation: A progress report

Krismer

Wenzel

Stadlbauer

et al. 2004

Critical Care Medicine

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“…Die Wertigkeit hypertoner/hyperonkotischer Lösungen in der präklinischen Schockphase ist bisher noch nicht ausreichend untersucht. Obwohl es durch die Anwendung hypertoner/hyperonkotischer Lösungen zu einer frühzeitigen Stabilisierung des Kreislaufs kommen kann, scheint die präklinische Behandlung bei Patienten mit relevanter oder unkontrollierter Blutung zu keiner Verbesserung des Überlebens zu führen [31,34,56].…”

Section: Schocktherapieunclassified

Traumatische thorakale Aortenruptur

et al. 2008

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Traumatic aortic rupture is a life-threatening injury which is frequently associated with blunt thoracic trauma or found coincidentally in heavily traumatized patients. Depending on the degree of disruption of the damaged aortic wall, vascular injury is associated with a high primary mortality rate and a significant risk of secondary aortic rupture. Early clinical signs which may indicate a ruptured thoracic aorta are left sided thoracic pain, reduced ventilation, tachycardia and dyspnoe as well as hypotension in the lower extremities. The primary aim for emergency treatment is to maintain vital organ function and to hemodynamically stabilize the patient. Surgical treatment was previously performed by either direct aortic suture or segmental alloplastic graft interposition using the clamp and sew technique with or without extra-anatomic shunts or extracorporeal circulation. However, endovascular stent graft implantation has now become another treatment option for traumatic aortic rupture. According to the reported data and our own experience there is increasing evidence that endovascular aortic repair might become the treatment of choice for patients with traumatic aortic rupture, with the option of an early, less invasive intervention thus avoiding thoracotomy. Regular follow-up is necessary to detect possible stent graft migration or leakage which could require additional endovascular or open surgical re-interventions.

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“…Die le benswichtigen Organe wurden dadurch besser durchblutet; dies war mit einer hö-heren Überlebensrate verbunden [32]. Wei terhin konnte in einem Tierversuch ge zeigt werden, dass eine aggressive Volumentherapie bei einer simulierten Leberruptur mit unkontrolliertem hämorrha-gischen Schock innerhalb von 15 min zum Tod aller Tiere führte, alle mit Vasopressin behandelten Tiere jedoch überlebten [31]. Auch beim simulierten Thoraxtrauma mit hämorrhagischem Schock konnte mit Vasopressin der Kreislauf stabilisiert und die Letalität gesenkt werden [11].…”

Section: Vasopressin Beim Schweren Hämorrhagischen Schockunclassified

Vasopressin zur Therapie eines therapierefraktären traumatisch-hämorrhagischen Schocks

Lienhart

Wenzel

Braun³

et al. 2007

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While fluid management is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is being controversially discussed, because it may worsen bleeding. In the irreversible phase of hemorrhagic shock that was unresponsive to volume replacement, airway management and catecholamines, vasopressin was beneficial due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain and decrease of fluid resuscitation requirements. The purpose of this multicenter, randomized, controlled, international trial is to assess the effects of vasopressin (10 IU IV) vs. saline placebo IV (up to 3 injections at least 5 min apart) in patients with prehospital traumatic hemorrhagic shock that persists despite standard shock treatment. The study will be carried out by helicopter emergency medical service teams in Austria, Germany, Czech Republic, Portugal, the Netherlands and Switzerland. Inclusion criteria are adult trauma patients with presumed traumatic hemorrhagic shock (systolic arterial blood pressure <90 mmHg) that does not respond to the first 10 min of standard shock treatment (endotracheal intubation, fluid resuscitation and use of vasopressors) after arrival of the first emergency physician at the scene. The time window for randomization will close after 30 min of shock treatment. Exclusion criteria are terminal illness, no intravenous access, age <18 years, injury >60 min before randomization, cardiac arrest before randomization, presence of a do-not-resuscitate order, untreated tension pneumothorax, untreated cardiac tamponade, or known pregnancy. Primary study end-point is the hospital admission rate, secondary end-points are hemodynamic variables, fluid resuscitation requirements and hospital discharge rate.

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Vasopressin, but Not Fluid Resuscitation, Enhances Survival in a Liver Trauma Model with Uncontrolled and Otherwise Lethal Hemorrhagic Shock in Pigs

Abstract: Vasopressin, but not fluid resuscitation or saline placebo, ensured survival with full recovery in this liver trauma model with uncontrolled and otherwise lethal hemorrhagic shock in pigs.

Cited by 104 publications

References 14 publications

Vasopressin during cardiopulmonary resuscitation: A progress report

Vasopressin during cardiopulmonary resuscitation: A progress report

Traumatische thorakale Aortenruptur

Vasopressin zur Therapie eines therapierefraktären traumatisch-hämorrhagischen Schocks

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