AVERT Shock Trial for Hemorrhagic Shock and the Use of mtDNA as a Biomarker During Trauma: an Interim Analysis

Trauma is the leading cause of death in people under the age of 40 years old, with hemorrhagic shock accounting for over 40% of deaths in the first 24 hours of admission. The current resuscitative strategy is based upon replenishing the intravascular volume with intravenous fluids and blood products. However, massive resuscitation is associated with serious complications such as acute respiratory distress syndrome, acute kidney injury, coagulopathy and infection. Indeed, the resuscitation with 6 or more units of blood product has been shown to be the greatest predictor of multi-organ failure. Large volume resuscitation also dilutes key hormones such as vasopressin which are needed to maintain vascular tone. Our previous research demonstrated that patients become deficient in vasopressin after transfusion with more than 5 units of blood product. We hypothesized that vasopressin use in patients presenting in hemorrhagic shock will result in a lower incidence of compli cations associated with over-resuscitation. We present an interim analysis of the data from our randomized, double blind, placebo-controlled study “Arginine Vasopressin for the Early Resuscitation of Traumatic (AVERT) Shock” which seeks to address the impact of early vasopressin supplementation during resuscitation. Free mitochondrial DNA (mtDNA) in plasma has also been suggested to play a role in the complications associated with trauma and therefore is being investigated as a potential biomarker for outcome. mtDNA has been shown in vitro to act as a danger-associated molecular pattern and trigger an inflammatory response. We developed refined methods for quantifying plasma mtDNA and present an analysis of its levels in trauma patients throughout their enrollment in the AVERT Shock Trial