Abstract
Resuscitation of patients in hemorrhagic shock remains one of the most challenging aspects of trauma care. We showed in experimental studies that vasopressin, but not fluid resuscitation, enabled short-term and long-term survival in a porcine model of uncontrolled hemorrhagic shock after penetrating liver trauma. In this case report, we present two cases with temporarily successful cardiopulmonary resuscitation (CPR) using vasopressin and catecholamines in uncontrolled hemorrhagic shock with subsequent cardiac arrest that was refractory to catecholamines and fluid replacement. In a third patient, an infusion of vasopressin was started before cardiac arrest occurred; in this case, we were able to stabilize blood pressure thus allowing further therapy. The patient underwent multiple surgical procedures, developed multi-organ failure, but was finally discharged from the critical care unit without neurological damage.
Zusammenfassung
Die Wiederbelebung von Patienten im hämorrhagischen Schock ist immer noch eine der größten Herausforderungen in der Traumabehandlung. Experimentelle Untersuchungen zeigen, dass der Einsatz von Vasopressin, nicht aber einer Volumenersatztherapie, das Kurz- und Langzeitüberleben von Schweinen mit unkontrolliertem hämorrhagischen Schock nach penetrierendem Lebertrauma verlängert. Im Folgenden werden 2 Fälle mit vorübergehend erfolgreicher kardiopulmonaler Reanimation mithilfe von Vasopressin bei Patienten im unkontrollierten hämorrhagischen Schock mit anschließendem Herzstillstand dargestellt. Die zuvor durchgeführten Versuche der Katecholamingabe und Volumenersatztherapie waren erfolglos verlaufen. Bei einer dritten Patientin wurde eine Infusion mit Vasopressin begonnen, bevor diese einen Herzstillstand erlitt. Hier konnte der Blutdruck stabilisiert werden, sodass weitere Therapiemaßnahmen möglich wurden. Die Patientin musste sich mehrerer chirurgischer Eingriffe unterziehen und entwickelte hierbei ein Multiorganversagen, letztendlich aber konnte sie die Intensivstation ohne neurologisches Defizit verlassen.
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Krismer, A.C., Wenzel, V., Voelckel, W.G. et al. Employing vasopressin as an adjunct vasopressor in uncontrolled traumatic hemorrhagic shock. Anaesthesist 54, 220–224 (2005). https://doi.org/10.1007/s00101-004-0793-y
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DOI: https://doi.org/10.1007/s00101-004-0793-y