Vasopressin during cardiopulmonary resuscitation: a progress report.
OBJECTIVE
In patients undergoing cardiopulmonary resuscitation, circulating endogenous vasopressin concentrations were significantly higher in successfully resuscitated patients than in patients who died. These observations have prompted several investigations to assess the role of vasopressin to improve cardiopulmonary resuscitation management.


METHODS
Literature review.


RESULTS
In the cardiopulmonary resuscitation laboratory, vasopressin improved vital organ blood flow, cerebral oxygen delivery, the probability of restoring spontaneous circulation, and neurologic recovery better than epinephrine. In pediatric preparations with asphyxia, epinephrine was superior to vasopressin, whereas in both pediatric pigs with ventricular fibrillation and adult porcine models with asphyxia, combinations of vasopressin and epinephrine proved to be highly effective. In addition, vasopressin enabled short- and long-term survival in a porcine model of uncontrolled hemorrhagic shock. In a recently published European, multiple-center trial, 1,219 adult patients with out-of-hospital cardiac arrest were randomized to receive two injections of either 40 IU of vasopressin or 1 mg of epinephrine followed by additional epinephrine if needed. The clinical study did not confirm laboratory data showing vasopressin to be more effective than epinephrine in ventricular fibrillation and pulseless electrical activity, but vasopressin was superior to epinephrine in patients with asystole. Vasopressin followed by epinephrine was more effective than epinephrine alone in the treatment of refractory cardiac arrest.


CONCLUSIONS
According to new data from the European vasopressin study, we suggest, first, the administration of 1 mg of epinephrine, followed alternately by 40 IU of vasopressin and 1 mg of epinephrine every 3 mins in adult cardiac arrest victims, regardless of the initial electrocardiographic rhythm.
Krismer
Anette C
AC
Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
Wenzel
Volker
V
Stadlbauer
Karl H
KH
Mayr
Viktoria D
VD
Lienhart
Hannes G
HG
Arntz
H Richard
HR
Lindner
Karl H
KH
D022561:Advanced Cardiac Life Support / Q000379:methods*; D000818:Animals; D004837:Epinephrine / Q000627:therapeutic use*; D005060:Europe; D006323:Heart Arrest / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013552:Swine; D014662:Vasoconstrictor Agents / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D014667:Vasopressins / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine