AVERT Shock
Trial question
What is the effect of low-dose supplementation of arginine vasopressin in patients with trauma and hemorrhagic shock?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
7.0% female
93.0% male
N = 100
100 patients (7 female, 93 male)
Inclusion criteria: trauma patients aged 18-65 years who received at least 6 U of any blood product within 12 hours of injury
Key exclusion criteria: prehospital CPR, emergency department thoracotomy, corticosteroid use, chronic renal insufficiency, coronary artery disease, or arginine vasopressin administration before enrollment
Interventions
N=49 arginine vasopressin supplementation (4 U of bolus followed by ≤ 0.04 U/min infusion for 48 hours to maintain a mean arterial BP of at least 65 mmHg)
N=51 placebo (an equivalent volume of saline infusion for 48 hours to maintain a mean arterial BP of at least 65 mmHg)
Primary outcome
Total volume of blood product transfused at 48 hours
1.4
2.9
2.9 L
2.2 L
1.4 L
0.7 L
0.0 L
Arginine vasopressin supplementation
Placebo
Significant decrease ▼
Significant decrease in total volume of blood product transfused at 48 hours (1.4 L vs. 2.9 L; AD -1.1 L, 95% CI -2.04 to 0)
Secondary outcomes
No significant difference in total vasopressor equivalents at 48 hours (0.4 g vs. 1.4 g; AD -0.23 g, 95% CI -1.37 to 0.53)
No significant difference in crystalloid equivalents at 48 hours (9.9 L vs. 11 L; AD -1.07 L, 95% CI -3.04 to 0.62)
No significant difference in death (12% vs. 12%; RR 1.04, 95% CI 0.36 to 3.01)
Safety outcomes
No significant difference in adverse events.
Significant difference in DVT (11% vs. 34%).
Conclusion
In trauma patients aged 18-65 years who received at least 6 U of any blood product within 12 hours of injury, arginine vasopressin supplementation was superior to placebo with respect to total volume of blood product transfused at 48 hours.
Reference
Carrie A Sims, Daniel Holena, Patrick Kim et al. Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial. JAMA Surg. 2019 Nov 1;154(11):994-1003.
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