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Vasopressin Supplementation during the Resuscitation of Hemorrhagic Shock

Principal Investigator: Carrie Sims, MD, MS
Institution: University of Pennsylvania

Trauma remains the leading cause of death for those under the age of forty in the United States, with a large percentage of patients dying from hemorrhagic shock within the initial hours after a severe injury. Although aggressive treatment with intravenous fluids and blood products has been the gold standard, massive resuscitation alters the neuroendocrine milieu needed to maintain vasomotor tone and is associated with the development of a vasopressin deficiency. Vasopressin is a critical hormone needed for blood pressure support during shock, and low levels are associated with recalcitrant hypotension, increased transfusion requirements, and additional morbidity. The goal of this research was to develop targeted interventions to address hemorrhagic shock. The pilot study (Vasopressin Supplementation during the Resuscitation of Hemorrhagic Shock – the AVERT Shock Trial) evaluated the clinical applicability of using the biomarker copeptin for predicting the need for resuscitation and to monitor vasopressin deficiency. Identifying and targeting neuroendocrine deficiencies during the resuscitation of trauma patients is a novel approach to ameliorate hypotension seen in late stage shock; limiting the need for aggressive volume and blood product resuscitation and decreasing the incidence of resuscitation associated complications. Currently, data from this study is being analyzed. 

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Publications

Sims CA, Isserman JA, Holena D, Sundaram LM, Tolstoy N, Greer S, Sonnad S, Pascual J, Reilly P. Exception from informed consent for emergency research: Consulting the trauma community. J Trauma Acute Care Surg. 2013;74:157-166.
DOI: 10.1097/TA.0b013e318278908a

Greer SE, Speck RM, Sundaram LM, Isserman J, Nathanson PG, Sonnad S, Sims CA. The community speaks: Analyzing attitudes about the Avert Shock trial and exception from informed consent (EFIC) in emergency research. J of Surg Res. 2013:179(2): 337. DOI: http://dx.doi.org/10.1016/j.jss.2012.10.733

Maher, Z, Grill, EK, Smith, BP, Sims, CA. Does proximity to violence negatively influence attitudes toward exception from informed consent in emergency research? J Trauma Acute Care Surg. 2015:79(3):364-371.
DOI: 10.1097/TA.0000000000000743