Acutely injured trauma patients may develop shock from several potential mechanisms, including hypovolemic shock from hemorrhage, neurogenic shock from traumatic brain injury (TBI) or spinal cord injury, obstructive shock from tension pneumothorax or pericardial tamponade, or a mix of several of these mechanisms. Regardless of the cause, restoration of adequate perfusion is of critical importance to reduce the morbidity and mortality of trauma patients with shock. Multiple interventions including hemorrhage control, volume resuscitation with intravenous fluids or blood products, and pleural decompression procedures are used to address some of these issues and are discussed elsewhere in the trauma compendium. The prehospital use of vasopressors to augment organ perfusion pressures seems theoretically appealing for settings where trauma patients have hemorrhagic shock that is refractory to volume resuscitation strategies alone, where blood products are not available, in cases of hypoperfusion caused by neurogenic shock, or to address mean arterial pressure (MAP) goals in severe spinal cord injury. The National Association of Emergency Medical Services Physicians (NAEMSP) reviewed the available evidence surrounding the prehospital use of vasopressors in shock related to trauma to develop the following recommendations as supported by the evidence summarized in the subsequent resource document.
Current evidence does not support the routine use of vasopressors by EMS clinicians for traumatic hemorrhagic shock and suggests the possibility of harm.Current evidence does not address the use of vasopressors by EMS clinicians in the treatment of patients with severe spinal cord injury presenting with neurogenic shock or to achieve specific mean arterial pressure goals in spine injured patients in the prehospital setting.Prehospital hypotension has been shown to be harmful to patients with TBI; however, there is currently no evidence to support or refute the use of vasopressors by EMS clinicians in the setting of TBI.