The Role of Selected Adjuncts in the Management of the Bleeding Trauma Patient: Calcium and Vasopressin

Abstract

Purpose of Review: This review summarizes emerging literature on calcium and vasopressin as pharmacological adjuncts in management of hemorrhage in trauma patient resuscitation, and how they may prove useful in promoting hemostasis, reduce blood product usage and improve mortality in trauma patients with hemorrhage. Recent Findings: Hypocalcemia has correlation with mortality and increased blood product usage in trauma patients. Calcium’s role in coagulation cascade may indicate use as early supplementation before transfusion in addition to repletion in hemorrhagic shock and MTP scenarios. Vasopressin has roles in vascular tone and coagulation, and early studies show a reduction in overall blood product usage without significant adverse events when used in hemorrhaging trauma patients, though effect on overall mortality requires further investigation. Summary: Calcium and vasopressin are promising pharmacologic adjuncts to transfusion in bleeding trauma patients. Additional research is needed for safety and efficacy in both therapies and for other potential pharmacologic options in their role for promoting hemostasis and reducing hemorrhage severity in bleeding trauma patients.