Effect of vasopressin on postresuscitation ventricular function: unknown consequences of the recent Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
OBJECTIVE
To compare the effect on postresuscitation left ventricular function of vasopressin vs. epinephrine used during cardiopulmonary resuscitation in a swine model of prolonged prehospital ventricular fibrillation.


METHODS
Prospective, randomized experimental study.


METHODS
University large animal resuscitation research laboratory.


METHODS
Forty-eight swine (29 +/- 1 kg).


METHODS
Resuscitation after 12.5 mins of untreated ventricular fibrillation, randomizing animals during cardiopulmonary resuscitation to treatment with epinephrine, vasopressin, or vasopressin followed by a vasopressin antagonist administered in the postresuscitation period.


RESULTS
Serial measurements of left ventricular systolic and diastolic function (prearrest, postresuscitation at 30 mins and 6 hrs) and 24-hr survival. Animals receiving vasopressin had more postresuscitation left ventricular dysfunction than those receiving epinephrine (p < .05). The vasopressin antagonist produced vasodilation and improved early postresuscitation left ventricular systolic and diastolic function but did not have a lasting effect on such postresuscitation ventricular function and decreased 24-hr survival compared with the use of vasopressin alone (3/16 vs. 10/16 survivors; p < .05).


CONCLUSIONS
Vasopressin use during cardiopulmonary resuscitation results in worse postresuscitation left ventricular function early but did not compromise 24-hr outcome. Reversal of vasopressin's effect with a specific V-1 antagonist in the postresuscitation period did not improve survival.
Kern
Karl B
KB
University of Arizona College of Medicine, Sarver Heart Center, Tucson, AZ, USA.
Heidenreich
Joseph H
JH
Higdon
Travis A
TA
Berg
Robert A
RA
Hilwig
Ronald W
RW
Sanders
Arthur B
AB
Anavy
Nathan
N
Ewy
Gordon A
GA
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D004837:Epinephrine / Q000494:pharmacology*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy*; D008297:Male; D017410:Practice Guidelines as Topic; D013552:Swine; D014662:Vasoconstrictor Agents / Q000494:pharmacology*; D014667:Vasopressins / Q000494:pharmacology*; D016277:Ventricular Function, Left / Q000187:drug effects*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine