A Small Dose of Arginine Vasopressin in Combination with Norepinephrine is a Good Early Treatment for Uncontrolled Hemorrhagic Shock After Hemostasis

Background

Limited fluid resuscitation has been proven to have a good effect on uncontrolled hemorrhagic shock. Arginine vasopressin (AVP) and norepinephrine (NE) were used to treat vasodilatory or septic shock, and were used to reduce the fluid requirement for uncontrolled hemorrhagic shock. Based on their pressor and hemodynamic stabilization effects, it is speculated that AVP and NE may be a good treatment for uncontrolled hemorrhagic shock at early stage after hemostasis.

Methods

Experiments were conducted in two parts. Each part had control, lactated Ringer's solution (LR), whole blood, NE, arginine vasopressin (AVP), NE+AVP, and AVP+NE+whole blood. Rats (n = 8–10/group), respectively, received LR, whole blood, NE (1 μg/kg) and AVP (0.1 U/kg) infusion alone, or in combination after 60 min hypotensive resuscitation (50 mmHg). The volume in each group was two times the volume of shed blood.

Results

Whole blood improved all observed parameters, particularly the tissue blood flow and mitochondrial function of liver and kidney, and the 12-h survival (50%). NE only increased the hemodynamics. 0.1 U/kg of AVP had a similar effect with whole blood on hemodynamics, tissue blood flow, mitochondrial function, and the 12-h survival. AVP+NE significantly improved all observed variables (P < 0.05 or 0.01), the12-h survival was 70%. Whole blood further potentiated the beneficial effect of AVP+NE, and 12-h animal survival rate in this group was 80%.

Conclusion

AVP+NE is a good treatment for uncontrolled hemorrhagic shock at the early stage after hemostasis if blood is unavailable. Whole blood transfusion can potentiate this beneficial effect of AVP+NE.

Key Words: uncontrolled hemorrhagic shock, fluid resuscitation, vasoactive agents, blood flow, mitochondrial function