A narrative review of prehospital hemorrhagic shock treatment with non-blood product medications

Caleb D. Knight, Vikhyat Bebarta, Michael A. Meledeo, Evan Ross, Xiaowu Wu, James Bynum, Steven Schauer, Todd Getz, Michael April

Research output: Contribution to journalArticlepeer-review


Background: Hemorrhagic shock remains a leading cause of death in both military and civilian trauma casualties. While standard of care involves blood product administration, maintaining normothermia, and restoring hemostatic function, alternative strategies to treat severe hemorrhage at or near the point of injury are needed. We reviewed adjunct solutions for managing severe hemorrhage in the prehospital environment. Methods: We performed a literature review by searching PubMed with a combination of several keywords. Additional pertinent studies were identified by crossreferencing primary articles. Clinical experience of each author was also considered. Results: We identified several promising antishock therapies that can be utilized in the prehospital setting: ethinyl estradiol sulfate (EES), polyethylene glycol 20,000 (PEG20K), C1 esterase inhibitors (e.g. Berinert, Cinryze), cyclosporin A, niacin, bortezomib, rosiglitazone, icatibant, diazoxide, and valproic acid (VPA). Conclusion: Several studies show promising adjunct treatment options in the management of severe prehospital hemorrhage. While some are rarely used, many others are readily available and commonly utilized for other indications. This suggests the potential for future use in resourcelimited settings. Human studies and case reports supporting their use are currently lacking.

Original languageEnglish (US)
StateAccepted/In press - 2023


  • RBC transfusion
  • transfusion practices (Adult)
  • transfusion practices (Surgical)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology


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