Neuromodulation as a new avenue for resuscitation in hemorrhagic shock.

Hemorrhagic shock (HS), a major cause of early death from trauma, accounts for around 40% of mortality, with 33-56% of these deaths occurring before the patient reaches a medical facility. Intravenous fluid therapy and blood transfusions are the cornerstone of treating HS. However, these options may not be available soon after the injury, resulting in death or a poorer quality of survival. Therefore, new strategies are needed to manage HS patients before they can receive definitive care. Recently, various forms of neuromodulation have been investigated as possible supplementary treatments for HS in the prehospital phase of care. Here, we provide an overview of neuromodulation methods that show promise to treat HS, such as vagus nerve stimulation, electroacupuncture, trigeminal nerve stimulation, and phrenic nerve stimulation and outline their possible mechanisms in the treatment of HS. Although all of these approaches are only validated in the preclinical models of HS and are yet to be translated to clinical settings, they clearly represent a paradigm shift in the way that this deadly condition is managed in the future.

© The Author(s) 2019.

KEYWORDS: Autonomic nervous system; Electroacupuncture; Hemorrhagic shock; Inflammation; Neuromodulation; Phrenic nerve stimulation; Resuscitation; Trigeminal nerve stimulation; Vagus nerve stimulation

PMID: 32232106 PMCID: PMC7098257 DOI: 10.1186/s42234-019-0033-z