Background Traumatic hemorrhagic shock is a critical condition caused by significant blood loss, leading to impaired tissue perfusion and high mortality. Although vasopressors such as noradrenaline and vasopressin are sometimes administered as adjuncts to fluid and blood product resuscitation, their role remains controversial due to concerns about end-organ perfusion and exacerbation of bleeding.

Objective This systematic review aims to evaluate the efficacy and safety of vasopressor administration in adult patients with traumatic hemorrhagic shock. The review will assess effects on mortality, organ dysfunction, transfusion requirements, adverse events, and tissue perfusion.

Methods We will include randomized controlled trials (RCTs), including cluster-randomized trials, comparing vasopressor use to standard care or no vasopressor in adult trauma patients with hemorrhagic shock. Databases to be searched include CENTRAL, MEDLINE (via PubMed), and Ichushi-Web. The Cochrane RoB 2 tool will be used to assess study quality. Where appropriate, meta-analyses will be conducted using a random-effects model. Subgroup and sensitivity analyses will be performed, and the certainty of evidence will be assessed using the GRADE approach.

Expected Contribution By synthesizing the available evidence, this review will help clarify the role of vasopressors in traumatic hemorrhagic shock, inform clinical practice and guidelines, and identify gaps for future research.

The authors have declared no competing interest.

This study is supported by the Japanese Association for the Surgery of Trauma.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data used in this review will be obtained from publicly available sources.