Prostacyclin in trauma patients with hemorrhagic shock: A randomized clinical trial

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  • Jo­hans­son, Par Ingemar
  • Christian Fenger Eriksen
  • Pernille E. Bovbjerg
  • Christine Gaarder
  • Marlene Pall
  • Hanne Hee Henriksen
  • Kristine H. Pedersen
  • Martin Vigstedt
  • Lange, Theis
  • Pål Aksel Næss
  • Mikkel Strømgaard Andersen
  • Hans Kirkegaard
  • Jakob Stensballe

BACKGROUND A main cause of trauma morbidity and mortality is multiple-organ failure, and endotheliopathy has been implicated. Pilot studies indicate that low-dose prostacyclin improves endothelial functionality in critically ill patients, suggesting that this intervention may improve trauma patient outcome. METHODS We conducted a multicenter, randomized, blinded, clinical investigator-initiated trial in 229 trauma patients with hemorrhagic shock who were randomized 1:1 to 72 hours infusion of the prostacyclin analog iloprost (1 ng/kg/min) or placebo. The primary outcome was the number of intensive care unit (ICU)-free days alive within 28 days of admission. Secondary outcomes included 28-day all-cause mortality and hospital length of stay. RESULTS The mean number of ICU-free days alive within 28 days was 15.64 days in the iloprost group versus 13.99 days in the placebo group (adjusted mean difference, -1.63 days [95% confidence interval (CI), -4.64 to 1.38 days]; p = 0.28). The 28-day mortality was 18.8% in the iloprost group versus 19.6% in the placebo group (odds ratio, 1.01 [95% CI, 0.51-2.0]; p = 0.97). The mean hospital length of stay was 19.96 days in the iloprost group versus 27.32 days in the placebo group (adjusted mean difference, 7.84 days [95% CI, 1.66-14.02 days], p = 0.01). CONCLUSION Iloprost did not result in a statistically significant increase in the number of ICU-free days alive within 28 days of admission, whereas it was safe and a statistically significant reduction in hospital length of stay was observed. Further research on prostacyclin in shocked trauma patients is warranted. LEVEL OF EVIDENCE Therapeutic/Care Management; Level II.

Original languageEnglish
JournalJournal of Trauma and Acute Care Surgery
Issue number3
Pages (from-to)476-481
Number of pages6
Publication statusPublished - 2024

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© Wolters Kluwer Health, Inc. All rights reserved.

    Research areas

  • hemorrhagic shock-induced endotheliopathy, prostacyclin, randomized clinical trial, Trauma

ID: 384656538