Vasopressin in cardiac arrest.
OBJECTIVE
To review the efficacy and safety of vasopressin in cardiac arrest.


METHODS
MEDLINE, EMBASE, and PubMed were searched (all to June 2005) for full-text English-language publications describing trials in humans. Search terms were vasopressin, epinephrine, adrenaline, heart arrest, cardiac arrest, and clinical trial.


METHODS
Prospective, randomized, controlled trials that evaluated efficacy or safety endpoints of vasopressin in the management of cardiac arrest were included. Efficacy outcomes included return of spontaneous circulation, successful resuscitation, survival to hospital admission, 24-hour survival, and survival to hospital discharge. Safety outcomes were as defined by each trial.


RESULTS
Three prospective trials were identified and included in this review. Vasopressin does not appear to offer any therapeutic advantage compared with epinephrine in the treatment of both in-hospital and out-of-hospital cardiac arrest, regardless of the presenting arrest rhythm. Although there is a suggestion that vasopressin may be effective in treatment of asystole, the evidence for this arises from a subgroup analysis that should be viewed as hypothesis generating. There are limited data describing the safety of vasopressin in cardiac arrest.


CONCLUSIONS
The current evidence for the use of vasopressin in cardiac arrest is indeterminate. Given the similarly equivocal evidence of efficacy for epinephrine, either drug could be considered the first-line agent in cardiac arrest. Placebo-controlled studies with appropriate statistical power are warranted to evaluate meaningful clinical outcomes, such as survival to hospital discharge. Further evaluation of the role of vasopressin in asystolic cardiac arrest and its use in combination with epinephrine is also justified.
Koshman
Sheri L
SL
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Zed
Peter J
PJ
Abu-Laban
Riyad B
RB
D002986:Clinical Trials as Topic; D003326:Coronary Circulation / Q000187:drug effects; D016206:Databases, Bibliographic; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006323:Heart Arrest / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014667:Vasopressins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine