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Br J Anaesth. 2018 Jun;120(6):1237-1244. doi: 10.1016/j.bja.2018.02.032. Epub 2018 Apr 14.

Effect of early use of noradrenaline on in-hospital mortality in haemorrhagic shock after major trauma: a propensity-score analysis.

Author information

1
Department of Anaesthesiology and Critical Care, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord-Val-De-Seine, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France. Electronic address: gausst@eclipso.de.
2
Department of Anaesthesiology and Critical Care, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
3
Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France.
4
Department of Anaesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France; Sorbonne University, UPMC Univ Paris 06, UMRS 1158, Paris, France.
5
Department of Anaesthesiology and Critical Care, Hôpital Européen, Georges Pompidou, AP-HP, Paris, France.
6
Department of Anaesthesiology and Critical Care, Hôpital Interarmées Percy, Clamart, France.
7
Department of Anaesthesiology and Critical Care, Hôpital Henri Mondor, AP-HP, Créteil, France.
8
Department of Anaesthesiology and Critical Care, Hôpital Henri Mondor, APHP, Créteil, France.
9
Anaesthesiology and Critical Care, Hôpital Interarmées Percy, Clamart, France.
10
University Paris Est and Department of Anaesthesiology and Critical Care, Hôpital Henri Mondor, APHP, Créteil, France.
11
University Paris Sud and Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, AP-HP, Kremlin Bicêtre, France.
12
Sorbonne University, UPMC Univ Paris 06 and Department of Anaesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France.
13
University Paris Descartes and Department of Anaesthesiology and Critical Care, Hôpital Européen Georges Pompidou, APHP, Paris, France.
14
University Denis Diderot and Beaujon University Hospital, Hôpitaux Universitaires Paris Nord-Val-De-Seine, Clichy, AP-HP, France.
15
Sorbonne University, UPMC Univ Paris 06, UMRS 1166 and Department of Emergency Medicine, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France.
16
Department of Anaesthesiology and Critical Care, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, AP-HP, Kremlin Bicêtre, France.
17
Brigade des Sapeurs de Pompiers Paris, Paris, France.
18
SAMU 94, Val de Marne, Hôpital Henri-Mondor, AP-HP, Créteil, France.
19
SAMU 77, Seine et Marne, Melun, France.
20
SAMU 93, Seine-St-Denis, AP-HP, Bobigny, France.
21
SAMU 92, Hauts-De-Seine, Garches, AP-HP, France.
22
SAMU 95, Val D'Oise, Pontoise, France.
23
SAMU 78, Yveslines, Versailles, France.
24
SAMU 91, L'Essonne, Corbeil, France.
25
SAMU 75, Paris, AP-HP, France.

Abstract

BACKGROUND:

The role of vasopressors in trauma-related haemorrhagic shock (HS) remains a matter of debate. They are part of the most recent European recommendations on the management of HS and are regularly used in France. We assessed the effect of early administration of noradrenaline in 24 h mortality of trauma patients in HS, using a propensity-score analysis.

METHODS:

The study included patients from a multicentre prospective regional trauma registry. HS was defined as transfusion of ≥4 erythrocyte-concentrate units during the first 6 h. Patients with a Glasgow coma scale=3 and pre-hospital traumatic cardiac arrest were excluded. The main outcome measure was in-hospital mortality. The explicative and adjustment variables for the outcome and treatment allocation were predetermined by a Delphi method. The in-hospital mortality of patients with and without early administration of noradrenaline was compared in a propensity-score model, including all predetermined variables.

RESULTS:

Of 7141 patients in the registry in the study period, 6353 were screened and 518 patients in HS (201 with early noradrenaline use and 317 without) were included and analysed. After propensity-score matching, 100 patients remained in each group, and the hazard-ratio mortality was 0.95 (95% confidence interval: 0.45-2.01; P=0.69).

CONCLUSIONS:

The results of the present study suggest that noradrenaline use in the early phase of traumatic HS does not seem to affect mortality adversely. This observation supports a rationale for equipoise in favour of a prospective trial of the use of vasopressors in HS after trauma.

KEYWORDS:

noradrenaline; propensity score; shock; trauma

PMID:
29793591
DOI:
10.1016/j.bja.2018.02.032

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