Renberg Mattias, Karlsson Tomas, Gellerfors Mikael, Gustavsson Jenny, Wellfelt Katrin, Günther Mattias
Department of Clinical Science and Education, Södersjukhuset, Section for Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
Rapid Response Car AISAB, Stockholm, Sweden.
Transfusion. 2025 May;65 Suppl 1(Suppl 1):S68-S79. doi: 10.1111/trf.18218. Epub 2025 Mar 23.
Hemorrhagic shock is the leading cause of preventable prehospital trauma deaths. While arginine vasopressin (AVP) is a well-known hormone with vasopressor effects, its potential for hemodynamic stabilization in prehospital hemorrhagic shock remains underexplored. This study investigated intramuscular (IM) AVP during hemorrhagic shock to evaluate its feasibility and efficacy for prehospital trauma resuscitation.
In this randomized, controlled, double-blinded trial, 16 swine (mean [standard deviation, SD] weight 56.2 [3.8] kg) underwent a mean (SD) 1205 (124) mL Class III hemorrhage for 45 min and 45 min of hypotension. Animals were randomized to 40 U IM AVP (n = 7) or NaCl (n = 9), followed immediately by 500 mL autologous whole blood transfusion over 30 and 120 min posttransfusion monitoring of hemodynamic, respiratory, and metabolic parameters.
AVP increased systolic arterial pressure 30 min after administration (mean increase: 33.5 mmHg vs. 7.5 mmHg, p < 0.05) and improved cardiac index (CI) 90 min after AVP (mean increase: 19.2% vs. 4.1% decrease, p < 0.05) and stroke volume (mean increase: 37.0% vs. 1.0%, p < 0.05). These effects normalized by 120 min. AVP did not affect respiratory parameters, oxygen delivery, or consumption. Increased serum AVP confirmed systemic uptake (median 68.7 pg/mL vs. 10.0 pg/mL in controls, p < 0.05).
IM AVP, combined with whole blood transfusion, transiently stabilized hemodynamics by increasing systemic vascular resistance index, systolic blood pressure, and CI without respiratory compromise. These findings suggest that IM AVP may be a viable intervention for prehospital resuscitation of severe hemorrhagic shock, offering vital short-term stabilization to facilitate transport to definitive care.
失血性休克是可预防的院前创伤死亡的主要原因。虽然精氨酸加压素（AVP）是一种众所周知的具有血管加压作用的激素，但其在院前失血性休克中稳定血流动力学的潜力仍未得到充分探索。本研究调查了失血性休克期间肌肉注射（IM）AVP，以评估其用于院前创伤复苏的可行性和有效性。
在这项随机、对照、双盲试验中，16头猪（平均[标准差，SD]体重56.2[3.8]kg）经历了平均（SD）1205（124）mL的III级出血，持续45分钟，并出现45分钟的低血压。动物被随机分为肌肉注射40U AVP组（n = 7）或生理盐水组（n = 9），随后立即在30分钟内输注500mL自体全血，并在输血后120分钟监测血流动力学、呼吸和代谢参数。
AVP给药后30分钟收缩动脉压升高（平均升高：33.5mmHg对7.5mmHg，p < 0.05），AVP给药后90分钟心脏指数（CI）改善（平均升高：19.2%对降低4.1%，p < 0.05），每搏输出量增加（平均升高：37.0%对1.0%，p < 0.05）。这些效应在120分钟时恢复正常。AVP不影响呼吸参数、氧输送或消耗。血清AVP升高证实了全身吸收（中位数68.7pg/mL对对照组的10.0pg/mL，p < 0.05）。
肌肉注射AVP联合全血输血，通过增加全身血管阻力指数、收缩压和CI，短暂稳定血流动力学，且无呼吸功能损害。这些发现表明，肌肉注射AVP可能是严重失血性休克院前复苏的一种可行干预措施，可提供重要的短期稳定，便于转运至确定性治疗。
