Introduction. We have previously shown that in patients with aortic dissection-induced haemorrhagic shock, the addition of an early intravenous injection of the melanocortin peptide ACTH-(1-24) (10 mg) to the standard treatment significantly increased survival rate (75% reduction in mortality) (1). Here we present the results obtained in a larger patient population, that confirm and strengthen the previous data. Materials and Methods. In our Cardiac Surgery Unit of Villa Maria Cecilia Hospital, all patients in haemorrhagic shock were consecutively enrolled in this study during the period 2002-2004 (112 subjects in all): 105 patients had aortic dissection (95 type A, 10 type B) and 7 patients had massive post-operative haemorrhage (mean estimated blood losses >5L). The European score was >15 and systolic blood pressure was <80 mmHg in all cases. All patients were intravenously bolus injected with 10 mg of ACTH-(1-24) at the moment of arrival into the casualty ward, or of display of signs of post-operative haemorrhage. Thereafter, all patients were subjected to the standard treatment and surgical intervention. Results. One hundred and two out of 105 patients with aortic dissection, and all patients with post-operative haemorrhage, survived. Three patients had permanent neurological deficits. Biochemical analyses indicated that ACTH treatment improved important parameters that are worsened in shock (e.g., TNF- and free radical levels, NFkB activation). Discussion. These results impressively confirm and extend our previous data (1). We cannot make a comparison with patients subjected to the standard treatment alone, because, after the demonstration that the addition of early ACTH-(1-24) to standard treatment significantly increases survival rate, in our Hospital all patients in haemorrhagic shock are treated also with ACTH-(1-24), for ethical reasons. However, all the available literature (see, for example, ref. 2) indicates a mortality rate >25% and neurologic complications in more than >20% of these patients, when subjected to the standard treatment alone. References. 1. Noera G., Lamarra M., Guarini S. and Bertolini A. (2002) The Lancet 358: 469-470 2. Sinatra R., Melina G., Pulitani I., Fiorani B., Ruvolo G. and Macino B. (2001) Ann. Thorac. Surg. 71: 33-38

Early treatment with ACTH-(1-24) in haemorrhagic shock in humans: futher data

LEONE, Sheila;
2005-01-01

Abstract

Introduction. We have previously shown that in patients with aortic dissection-induced haemorrhagic shock, the addition of an early intravenous injection of the melanocortin peptide ACTH-(1-24) (10 mg) to the standard treatment significantly increased survival rate (75% reduction in mortality) (1). Here we present the results obtained in a larger patient population, that confirm and strengthen the previous data. Materials and Methods. In our Cardiac Surgery Unit of Villa Maria Cecilia Hospital, all patients in haemorrhagic shock were consecutively enrolled in this study during the period 2002-2004 (112 subjects in all): 105 patients had aortic dissection (95 type A, 10 type B) and 7 patients had massive post-operative haemorrhage (mean estimated blood losses >5L). The European score was >15 and systolic blood pressure was <80 mmHg in all cases. All patients were intravenously bolus injected with 10 mg of ACTH-(1-24) at the moment of arrival into the casualty ward, or of display of signs of post-operative haemorrhage. Thereafter, all patients were subjected to the standard treatment and surgical intervention. Results. One hundred and two out of 105 patients with aortic dissection, and all patients with post-operative haemorrhage, survived. Three patients had permanent neurological deficits. Biochemical analyses indicated that ACTH treatment improved important parameters that are worsened in shock (e.g., TNF- and free radical levels, NFkB activation). Discussion. These results impressively confirm and extend our previous data (1). We cannot make a comparison with patients subjected to the standard treatment alone, because, after the demonstration that the addition of early ACTH-(1-24) to standard treatment significantly increases survival rate, in our Hospital all patients in haemorrhagic shock are treated also with ACTH-(1-24), for ethical reasons. However, all the available literature (see, for example, ref. 2) indicates a mortality rate >25% and neurologic complications in more than >20% of these patients, when subjected to the standard treatment alone. References. 1. Noera G., Lamarra M., Guarini S. and Bertolini A. (2002) The Lancet 358: 469-470 2. Sinatra R., Melina G., Pulitani I., Fiorani B., Ruvolo G. and Macino B. (2001) Ann. Thorac. Surg. 71: 33-38
2005
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11564/251840
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact