Bench-to-bedside review: Latest results in hemorrhagic shock

Hemorrhagic shock is a leading cause of death in trauma patients
worldwide. Bleeding control, maintenance of tissue oxygenation with
fluid resuscitation, coagulation support, and maintenance of
normothermia remain mainstays of therapy for patients with
hemorrhagic shock. Although now widely practised as standard in the
USA and Europe, shock resuscitation strategies involving blood
replacement and fluid volume loading to regain tissue perfusion and
oxygenation vary between trauma centers; the primary cause of this
is the scarcity of published evidence and lack of randomized
controlled clinical trials. Despite enormous efforts to improve
outcomes after severe hemorrhage, novel strategies based on
experimental data have not resulted in profound changes in
treatment philosophy. Recent clinical and experimental studies
indicated the important influences of sex and genetics on
pathophysiological mechanisms after hemorrhage. Those findings
might provide one explanation why several promising experimental
approaches have failed in the clinical arena. In this respect, more
clinically relevant animal models should be used to investigate
pathophysiology and novel treatment approaches. This review points
out new therapeutic strategies, namely immunomodulation,
cardiovascular maintenance, small volume resuscitation, and so on,
that have been introduced in clinics or are in the process of being
transferred from bench to bedside. Control of hemorrhage in the
earliest phases of care, recognition and monitoring of individual
risk factors, and therapeutic modulation of the inflammatory immune
response will probably constitute the next generation of therapy in
hemorrhagic shock. Further randomized controlled multicenter
clinical trials are needed that utilize standardized criteria for
enrolling patients, but existing ethical requirements must be
maintained.