Froedtert and The Medical College of Wisconsin, Department of Pharmacy, Milwaukee, Wisconsin,
The Medical College of Wisconsin School of Pharmacy, Milwaukee, Wisconsin.
WMJ. 2020 Dec;119(4):240-247.
Prehospital medical teams encounter patients with varying states of shock that require the use of vasopressors for hemodynamic support during transport. Selection of a vasopressor is challenging due to the absent comparative literature in prehospital medicine, as well as practical limitation of use in an ambulance.
This article discusses specific challenges in the delivery of vasopressor support for hemodynamically compromised patients in the prehospital environment. Discussion includes the current state of vasopressor use in prehospital medicine, use of a patient-specific agent selection or "one-vasopressor-fits-all" modality, as well as considerations for each vasopressor based on practical, pharmacologic, and comparative evidence-based evaluations.
There are currently many limitations to assessment of shock etiology in the prehospital setting. A "one-vasopressor-fits-all" strategy may be most feasible for most prehospital emergency medical services (EMS) systems. No clear difference in extravasation exists amongst agents. Based on current evidence, norepinephrine may be more efficacious and have a better safety profile than other vasopressors in cardiogenic, distributive, and neurogenic shocks. Due to its suitability for most shocks, norepinephrine is a reasonable agent for EMS systems to employ as a "one-size-fits-all" vasopressor.
院前医疗团队会遇到不同休克状态的患者，在转运过程中需要使用血管加压素来支持血液动力学。由于院前医学中缺乏比较文献，以及在救护车内使用的实际限制，选择血管加压素具有挑战性。
本文讨论了在院前环境中为血液动力学受损患者提供血管加压素支持的具体挑战。讨论包括目前院前医学中血管加压素的使用情况、使用针对特定患者的药物选择或“一种血管加压素适合所有”模式，以及基于实际、药理学和基于比较的循证评估，对每种血管加压素的考虑因素。
目前，在院前环境中评估休克病因存在许多限制。对于大多数院前急救医疗服务（EMS）系统来说，“一种血管加压素适合所有”策略可能是最可行的。在血管外渗方面，各种药物之间没有明显差异。基于现有证据，去甲肾上腺素在治疗心源性、分布性和神经性休克方面可能比其他血管加压素更有效且具有更好的安全性。由于其适用于大多数休克，去甲肾上腺素是 EMS 系统作为“一种适合所有”血管加压素的合理药物。
