Department of Emergency, Denver Health and Hospital Authority, Denver, Colorado, USA.
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Transfusion. 2023 May;63 Suppl 3:S256-S262. doi: 10.1111/trf.17324. Epub 2023 Apr 19.
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.
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.
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).
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.
失血性休克仍然是军事和民用创伤伤员死亡的主要原因。虽然标准的治疗方法包括输血、保持正常体温和恢复止血功能，但在创伤现场或附近需要替代策略来治疗严重出血。我们回顾了在院前环境中处理严重出血的辅助治疗方法。
我们通过在 PubMed 上搜索几个关键词的组合进行了文献回顾。通过交叉引用主要文章，确定了其他相关研究。每位作者的临床经验也被考虑在内。
我们确定了几种有前途的抗休克疗法，可在院前环境中使用：硫酸雌二醇（EES）、聚乙二醇 20,000（PEG20K）、C1 酯酶抑制剂（如 Berinert、Cinryze）、环孢素 A、烟酸、硼替佐米、罗格列酮、依替巴肽、二氮嗪和丙戊酸（VPA）。
几项研究表明，在严重的院前出血管理中，有一些有前途的辅助治疗选择。虽然有些很少使用，但许多其他药物在其他适应症中很常见且常用。这表明在资源有限的情况下有未来使用的潜力。目前缺乏支持其使用的人体研究和病例报告。
