Efficacy and safety of vasopressor use in adult patients with traumatic hemorrhagic shock: systematic review

Background Traumatic hemorrhagic shock is a critical condition caused by significant blood loss, leading to impaired tissue perfusion and high mortality. Although vasopressors such as noradrenaline and vasopressin are sometimes administered as adjuncts to fluid and blood product resuscitation, their role remains controversial due to concerns about end-organ perfusion and exacerbation of bleeding. Objective This systematic review aims to evaluate the efficacy and safety of vasopressor administration in adult patients with traumatic hemorrhagic shock. The review will assess effects on mortality, organ dysfunction, transfusion requirements, adverse events, and tissue perfusion. Methods We will include randomized controlled trials (RCTs), including cluster-randomized trials, comparing vasopressor use to standard care or no vasopressor in adult trauma patients with hemorrhagic shock. Databases to be searched include CENTRAL, MEDLINE (via PubMed), and Ichushi-Web. The Cochrane RoB 2 tool will be used to assess study quality. Where appropriate, meta-analyses will be conducted using a random-effects model. Subgroup and sensitivity analyses will be performed, and the certainty of evidence will be assessed using the GRADE approach. Expected Contribution By synthesizing the available evidence, this review will help clarify the role of vasopressors in traumatic hemorrhagic shock, inform clinical practice and guidelines, and identify gaps for future research.