Use of Vasopressor Increases the Risk of Mortality in Traumatic Hemorrhagic Shock: A Nationwide Cohort Study in Japan

Objectives: To evaluate the possible association of vasopressor use with mortality in traumatic hemorrhagic shock patients. Design: Retrospective cohort study. Setting: Traumatic hemorrhagic shock patients at 260 emergency hospitals in Japan between 2004 and 2015. Patients: Three-thousand five-hundred fifty-one traumatic hemorrhagic shock patients who had systolic hypotension (< 90 mm Hg) on arrival at the emergency department and a blood transfusion received within the first 24 hours. Interventions: The use of vasopressor for traumatic hemorrhagic shock within the first 24 hours. Measurements and Main Results: Among 236,698 trauma patients, 3,551 were included in the study. Overall, 198 of 459 patients (43%) in the vasopressor+ group expired compared with 481 of 3,092 patients (16%) in the vasopressor– group. Use of vasopressor had an odds ratio of 2.172 (95% CI, 1.666–2.833) for in-hospital mortality adjusted for age, gender, year of onset, cause of injury, mechanism of injury, vital signs at the emergency department, Injury Severity Score, use of prehospital IV fluid, and volume of blood transfusion within the first 24 hours. In the propensity score-matched cohort and two subgroup analyses (massive transfusion and survivable injury models), use of vasopressor was associated with higher mortality (odds ratio, 2.168; 95% C, 1.442–3.320), (odds ratio, 2.029; 95% CI, 1.414–2.911; massive transfusion model), and (odds ratio, 1.959; 95% CI, 1.364–2.814; survivable injury model). Conclusions: Use of vasopressor for traumatic hemorrhagic shock was associated with mortality after controlling for biases (trauma severity; volume of fluid resuscitation).