Utility and outcomes of prehospital vasopressors infusion in trauma patients: a systematic review.

Abstract

Traumatic hemorrhagic shock (THS) remains a leading cause of potentially preventable mortality in the prehospital setting. The role of prehospital vasopressors (PhVP) before definitive hemorrhage control during prehospital trauma management remains uncertain. We aimed to evaluate the utility and association between PhVP use and clinical outcomes in trauma patients presenting with hypotension or at risk of the THS. A systematic review of observational studies was conducted and studies were retrieved through MEDLINE/PubMed and CENTRAL databases search between 2015 and 2026. Studies participants were adult trauma patients with hypotension or at risk of THS receiving continuous infusion of PhVP compared with those who received prehospital standard care alone. Outcomes included all-cause in-hospital mortality, massive blood transfusion use, and trauma-induced coagulopathy (TIC). Risk of bias, study selection, and certainty of evidence were independently evaluated, followed by qualitative synthesis. Among 678 records identified, five retrospective studies (31 849 patients) were eligible. A total of 1443 patients received PhVP, with substantial variation in exposure across studies. Two studies reported no significant association between PhVP and mortality after adjustment, while another two showed a significant association. A military study revealed significantly lower adjusted survival [adjusted odds ratio (aOR): 0.32, 95% confidence interval (CI): 0.18-0.56]. One study showed a significant association between PhVP and massive blood transfusion use (aOR: 4.97, 95% CI: 1.24-19.91) and TIC (aOR: 3.05, 95% CI: 1.58-5.90). Current evidence on the utility and outcomes of PhVP in trauma is limited to very low-certainty observational data. Only one study showed a significant association between PhVP use and increased mortality after adjustment. Prospective studies are required to establish safety and specific clinical indications.