Pressing Matters: Vasopressors in Trauma Resuscitation

Abstract Purpose of Review This goal of this review is to examine the evolving role of vasopressors in trauma resuscitation, with a particular interest in patients with penetrating trauma, hemorrhagic shock, and refractory hypotension. We evaluate the physiologic basis, current evidence, and clinical scenarios in which vasopressors may be beneficial. Recent Findings Traditional trauma resuscitation guidelines have consistently discouraged vasopressor use. However, there is emerging literature supporting the selective use of vasopressors to improve hemodynamic stability during trauma resuscitation efforts. Clinical studies support improved blood pressure and reduced transfusion requirements; however definitive mortality benefits have not been established. Summary Current evidence does not support routine vasopressor use in trauma resuscitation. Nevertheless, vasopressors may serve as important adjunct to a balanced trauma resuscitation plan in select patients and clinical scenarios. Future large multicenter randomized control trials are needed to help define optimal patient selection, timing of intervention, and outcome benefits to vasopressors in trauma resuscitation.