Prehospital Norepinephrine and Early Mortality in Traumatic Shock
Condition: Traumatic Shock; Hemorrhagic Shock; Traumatic Brain Injury; Hypotension and Shock
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Hypotension; Shock; Shock, Hemorrhagic; Shock, Traumatic
Study type: Observational

Summary: 
      The effect of early, prehospital norepinephrine use in patients with traumatic shock on
      mortality is unknown. Recent existing observational evidence from single system data (US,
      France, Japan) are conflicting. The investigators hypothesize that prehospital norepinephrine
      is associated with decreased mortality when used in patients with traumatic shock.
    

Detailed description: 
      Prehospital hypotension is associated with worse clinical outcomes in patients who sustain
      traumatic injuries. Administration of vasoactive medications, including norepinephrine, is
      not advocated in North American trauma systems due to the belief that vasopressors will
      worsen clinical outcomes and increase mortality. However, in European trauma systems
      prehospital vasopressor administration is included as part of the guidelines for the
      management of hypotension and hemorrhagic shock. There are multiple physiologic explanations
      for why prehospital vasopressor administration may be useful in patients with traumatic
      shock, such as providing adequate blood pressure to maintain vital signs until arrival at the
      trauma center, allowing adequate organ perfusion in the setting of low blood flow, and
      supplementing decreased hormone production in the later stages of hemorrhagic shock.

      The purpose of this retrospective study is to investigate if prehospital norepinephrine
      administration is associated with decreased mortality in patients with traumatic shock. The
      investigators will collect patient data from previously collected sources of information and
      trauma databases from three separate locations: the TRAUMABase consortium in Paris, France;
      TRENAU trauma database from Grenoble, France; and the R Adams Cowley Shock Trauma Center in
      Baltimore, MD, USA. The investigators will perform statistical modeling to propensity score
      match patients that received prehospital vasopressors with patients that did not receive
      prehospital vasopressors and assess the association with 24-hour and 28-day mortality.
    

Intervention name(s): Norepinephrine
Intervention type(s): Drug
Intervention description(s): Trauma patients with prehospital or arrival to the trauma center hypotension, defined as a systolic blood pressure <100 mmHg, that received norepinephrine during prehospital transport or in the resuscitation unit.
Intervention MeSH terms: Norepinephrine
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        The study population will be collected from the previously collected trauma database at
        three separate locations, as previously described. These databases are collected,
        maintained, and managed by professional medical staff.
      
Keywords: hypotension; norepinephrine; traumatic shock