Epinephrine and vasopressin during cardiopulmonary resuscitation.
Epinephrine (adrenaline) and vasopressin have been by far the most commonly studied vasopressors in experimental cardiac arrest. Despite animal experimental studies suggesting improved outcomes in experimental cardiac arrest, clinical trials of pressor agents have failed to show clear cut benefit from either vasopressin or epinephrine, although few, if any, trials compared pressor agents to a placebo. The action of vasopressors in the heart, particularly beta1-adrenergic stimulation, is associated with adverse cardiac effects including post-resuscitation myocardial dysfunction, worsening ventricular arrhythmias, and increasing myocardial oxygen consumption. Alpha2-adrenergic agonists, in experimental studies, show great promise in improving outcomes in experimental cardiac arrest, but have not been studied in humans. The combination of epinephrine and vasopressin may be effective, but has been incompletely studied. Clinical trials of vasopressor agents, which minimize direct myocardial effects are needed.
Zhong
Jing-quan
JQ
Department of Medicine, University of Toronto and Division of Cardiology, St. Michael's Hospital, 30 Bond St., 6-027 Queen Wing, Toronto, Ont., Canada M5B 1W8.
Dorian
Paul
P
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004195:Disease Models, Animal; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine