Abstract 341: Vasopressin With Low-Volume Resuscitation is Highly Effective for Resuscitation and Survival From Severe Hemorrhagic Shock

Abstract

Background: We have previously shown in a swine model of controlled bleeding that vasopressin (VP) infusion promotes hemodynamic stabilization. We hypothesized that administering VP with or without modest amounts of normal saline (NS, half the volume of blood removed) could improve survival from severe and protracted hemorrhagic shock. Methods: Hemorrhagic shock was induced in 24 pigs by removing blood according to a mono-exponential decay function to 65% or 75% of the animal’s blood volume in 60 or 80 minutes. Pigs were randomized 1:1 to receive an intraosseous infusion of VP at a constant rate of 0.04 U/kg•min-1 from the onset of blood removal until the start of blood reinfusion with NS given at the end of hemorrhage over 30 minutes in half of the pigs. Results: Survival analysis by Kaplan-Meier method is shown in Figure comparing the effects of administering VP and NS (VP-NS), VP without NS (VP-noNS), no VP but NS (noVP-NS), and neither VP nor NS (noVP-noNS). The 72-hour survival was significantly different (p=0.009 by Log-rank test), with the highest survival in animals that received both VP and NS (100%) followed by VP-noNS (37.5%), noVP-NS (25%), and noVP-noNS (0%) regardless of shock severity. Conclusion: Intraosseous infusion of vasopressin in combination with normal saline was highly effective in securing initial resuscitation and 72-hour survival under conditions of severe hemorrhagic shock.