Vasopressin Supplementation during the Resuscitation of Hemorrhagic Shock
Carrie Sims, MD, MS

Trauma remains the leading cause of death in the United States for people under the age of 40 years old. Although injured patients are routinely given intravenous fluids and blood transfusions in order to treat their injuries, receiving a lot of fluids and blood products may not be entirely helpful and has been associated with the development of serious complications including injury to the lungs and decreased ability to form blood clots. Massive resuscitation is also associated with a decrease in vasopressin – a hormone needed to support the blood pressure during hemorrhagic shock. Low levels of vasopressin are associated with higher blood transfusion requirements, the need for more medications to support blood pressure, and longer stay in the intensive care unit.

Although giving vasopressin at high doses has been shown to improve blood pressure, decrease blood loss and improve survival in animal models with lethal blood loss, clinical studies investigating the use of vasopressin in trauma patients are limited to case reports.

We will conduct a multicenter, randomized control trial investigating the impact of using vasopressin (0.04 units/min) versus normal saline (placebo) during the resuscitation of 100 severely injured trauma patients. We will also identify risk factors for vasopressin deficiency in trauma patients and evaluate whether or not copeptin, a stable protein secreted with vasopressin, is helpful in predicting the need for blood transfusions, triaging injured patients, or monitoring vasopressin levels during resuscitation. By identifying and targeting hormone deficiencies during the resuscitation of trauma patients, we hope to decrease the need for aggressive volume and blood product resuscitation and minimize the incidence of resuscitation-associated complications.

This proposal supports the National Trauma Institute’s stated priorities of predicting resuscitation requirements and developing resuscitation strategy/fluids that will allow for the minimization of shock.