2025 Southeastern Residency Conference

Title: Evaluating the Safety and Efficacy of Vasopressin in Patients with Hemorrhagic Shock


Authors: Amanda Fisher, Martin Gordon, Sarah Frye


Objective: Evaluate the safety and efficacy of vasopressin on blood and fluid requirements in hemorrhagic shock.


Self-Assessment Question: True or false: In this study, patients who received vasopressin had significantly lower requirements of blood products compared to those who did not receive vasopressin.


Background: Hemorrhagic shock is associated with a high rate of mortality in the first 24 hours following injury. Management includes stopping the bleeding, aggressive fluid resuscitation, and preventing hypotension. Complications of fluid resuscitation include increased bleeding, acute respiratory distress (ARDS), hemodilution, and hypothermia. There is controversy over whether early initiation of vasopressors can reduce fluid requirements and restore hemodynamics. Arginine vasopressin (AVP) is a neuropeptide that is secreted in response to hypotension by the posterior pituitary. It is essential in maintaining vasomotor tone in hypovolemic and septic shock, and secretion is associated with vasoconstriction. In hemorrhagic shock, patients are at risk of AVP deficiency in the first 48 hours of injury. While not currently recommended by the Advanced Trauma Life Support guidelines, vasopressors can be used when blood pressure is unable to be maintained despite volume resuscitation and are addressed in the European guidelines. This study is designed to compare vasopressin used adjunctly with a catecholamine vasopressor to a catecholamine vasopressor alone on the cumulative volume of blood products infused in a 48-hour period in trauma patients admitted with hemorrhagic shock.


Methods: This was a single center, retrospective, cohort study that evaluated the safety and efficacy of utilizing vasopressin with catecholamine vasopressors on the cumulative volume of blood products in patients with hemorrhagic shock. Included patients had a diagnosis of hemorrhagic shock, received catecholamine vasopressors, and were treated in an adult critical care unit from January 2020 to January 2024.Patients were excluded if they received CPR on arrival or immediately prior to hemorrhagic shock diagnosis, those with “do not resuscitate” orders at the time of diagnosis, and those who had hemorrhagic shock due to a gastrointestinal bleed. The primary outcome of the study was the cumulative volume of blood products infused within 48 hours after diagnosis of hemorrhagic shock. Secondary outcomes included cumulative volume of crystalloid fluids, total vasopressor requirements, ICU length of stay, and 30-day mortality.


Results: A total of 63 patients met inclusion criteria with 15 patients in the vasopressin group and 48 in the vasopressor only group. Patients in the vasopressin group received 10 units of blood compared to 12 units of blood in the vasopressor only group (p=0.846). Those in the vasopressin group had higher cumulative vasopressor requirements over a 48-hour period (12,621 mcg norepinephrine equivalents vs 240.5 mcg norepinephrine equivalents, p=0.002) and had a longer duration of mechanical ventilation compared to the vasopressor only group (4 days vs 2 days, p=0.023). There were no significant differences in cumulative fluid, 30-day mortality, ICU and hospital length of stays, and adverse events.


Conclusion: This study demonstrated that the use of vasopressin did not decrease the volume of blood products utilized in hemorrhagic shock patients; however, patients receiving vasopressin had higher vasopressor requirements and required mechanical ventilation longer than those who received vasopressors alone.