UMEM Educational Pearls

Category: Trauma

Title: Vasopressors in trauma? Maybe?

Keywords: trauma, vasopressors, mass transfusion, uncertainty (PubMed Search)

Posted: 5/7/2023 by Robert Flint, MD (Updated: 5/29/2024)
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This extensive review looks at the literature surrounding vasopressors in trauma. Take away points are:

1.     Most of the studies were done when the use of crystalloid was still being used as initial resuscitation fluid instead of blood.

2.     Use of whole blood and mass hemorrhage protocols are not reflected in the literature regarding vasopressor use.

3.     There are physiologic reasons vasopressors could be useful, particularly in head injured patients where we want increased mean arterial pressures.

4.     European guidelines include vasopressor use whereas American ones do not.

5.     Vasopressin and norepinephrine appear to be the vasopressors of choice if using a vasopressor in a trauma patient.

6.     We need better studies looking at this topic

7.     We need better studies looking at permissive hypotension in trauma now that our resuscitative strategy emphasizes mass hemorrhage protocol of blood, blood products, TXA and hemorrhage control.

8.     As with all things in medicine, never say never.


Richards, Justin E. MD*; Harris, Tim MD†,‡; Dünser, Martin W. MD§; Bouzat, Pierre MD, PhD?; Gauss, Tobias MD¶. Vasopressors in Trauma: A Never Event?. Anesthesia & Analgesia 133(1):p 68-79, July 2021. | DOI: 10.1213/ANE.0000000000005552