The job of the modern trauma surgeon faced with a patient in hemorrhagic shock is to balance the competing priorities and demands between resuscitation and restoration of normal perfusion vs the potential adverse effects of resuscitation practices or products. In addition, these therapeutic decisions involve balancing multiple other variables (physiology, active bleeding, brain injury, and organ dysfunction) that are also dynamically changing as therapy is delivered. Thus, hemorrhagic shock in trauma represents an area that is critically in need of high-quality evidence and difficult to model in any standardized study design or protocol. In this issue of JAMA Surgery, Sims and colleagues1 are to be congratulated for performing a high-quality randomized clinical trial examining the addition of low-dose vasopressin (LDV) to the early resuscitation of patients with trauma and hemorrhagic shock (the AVERT Shock Trial). In examining the results of this study, we must consider the direct findings as well as the likely interpretations and extrapolations. The primary direct finding is that the addition of LDV resulted in significantly fewer blood products being administered in the first 48 hours, with a secondary finding of a lower deep venous thrombosis rate in the LDV group.
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Martin MJ. Vasopressin as an Early Adjunct to Resuscitation in Hemorrhagic Shock: Crisis AVERTed? JAMA Surg. 2019;154(11):1003–1004. doi:10.1001/jamasurg.2019.2905
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