title: Vasopressin administered with epinephrine is associated with a return of a pulse in out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  Recent data suggest that using vasopressin in combination with epinephrine (adrenaline) may improve treatment of out-of-hospital cardiac arrest. This study examined local experience with the combination of epinephrine and vasopressin administration.
  
  
  METHODS
  Data were obtained from an urban, municipal emergency medical service that does not include vasopressin in its formulary. A physician is dispatched to the scene of all cardiac arrest patients treated by this system. Vasopressin could be administered in addition to epinephrine to subjects with out-of-hospital cardiac arrest by the on-scene physician. Demographic information, drug administration and return of pulses were abstracted from patient care records for a 1-year interval. Multivariate logistic regression was used to assess the relationship between vasopressin use and outcomes.
  
  
  RESULTS
  During the study period, data were available for 298 subjects receiving epinephrine-only (n=231, 78%), a combination of 40 IU vasopressin and epinephrine (n=37, 12%) or no vasopressor drugs (n=30, 10%). Among patients receiving vasopressor drugs, pulse was restored for 74 subjects (28%), and 56 subjects (21%) had a pulse on arrival at the hospital. Return of pulses was associated with witnessed collapse, bystander CPR, and an initial ECG rhythm of ventricular fibrillation or tachycardia. Subjects receiving vasopressin and epinephrine were more likely to have a return of pulses during the resuscitation (LR: 2.73; 95% CI: 1.24, 6.03) and at hospital arrival (3.85; 1.71, 8.65) than subjects treated with epinephrine alone.
  
  
  CONCLUSIONS
  There is an association between using vasopressin in combination with epinephrine and restoration of circulation after out-of-hospital cardiac arrest.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 400, Pittsburgh, PA 15213, USA.
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.forename: Guy E
authors.initials: GE
authors.lastname: Guimond
authors.forename: David
authors.initials: D
authors.lastname: Hostler
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
mesh_terms: D000368:Aged; D001775:Blood Circulation / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011674:Pulse; D012189:Retrospective Studies; D014505:Urban Population; D014667:Vasopressins / Q000008:administration & dosage*
chemical_list: D002317:Cardiovascular Agents; D014667:Vasopressins; D004837:Epinephrine