title: Arginine vasopressin in advanced cardiovascular failure during the post-resuscitation phase after cardiac arrest.
abstract: Arginine vasopressin (AVP) has been employed successfully during cardiopulmonary resuscitation, but there exist only few data about the effects of AVP infusion for cardiovascular failure during the post-cardiac arrest period. Cardiovascular failure is one of the main causes of death after successful resuscitation from cardiac arrest. Although the "post-resuscitation syndrome" has been described as a "sepsis-like" syndrome, there is little information about the haemodynamic response to AVP in advanced cardiovascular failure after cardiac arrest. In this retrospective study, haemodynamic and laboratory variables in 23 patients with cardiovascular failure unresponsive to standard haemodynamic therapy during the post-cardiac arrest period were obtained before, and 30 min, 1, 4, 12, 24, 48, and 72 h after initiation of a supplementary AVP infusion (4 IU/h). During the observation period, AVP significantly increased mean arterial blood pressure (58+/-14 to 75+/-19 mmHg, p < 0.001), and decreased noradrenaline (norepinephrine) (1.31+/-2.14 to 0.23+/-0.3 microg/kg/min, p = 0.03), adrenaline (epinephrine) (0.58+/-0.23 to 0.04+/-0.03 microg/kg/min, p = 0.001), and milrinone requirements (0.46+/-0.15 to 0.33+/-0.22 microg/kg/min, p < 0.001). Pulmonary capillary wedge pressure changed significantly (p < 0.001); an initial increase being followed by a decrease below baseline values. While arterial lactate concentrations (95+/-64 to 21+/-18 mg/dL, p < 0.001) and pH (7.27+/-0.14 to 7.4+/-0.14, p < 0.001) improved significantly, total bilirubin concentrations (1.12+/-0.95 to 3.04+/-3.79 mg/dL, p = 0.001) increased after AVP. There were no differences in the haemodynamic or laboratory response to AVP between survivors and non-survivors. In this study, advanced cardiovascular failure that was unresponsive to standard therapy could be reversed successfully with supplementary AVP infusion in >90% of patients surviving cardiac arrest.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. viktoria.mayr@uibk.ac.at
authors.forename: Viktoria
authors.initials: V
authors.lastname: Mayr
authors.forename: Günter
authors.initials: G
authors.lastname: Luckner
authors.forename: Stefan
authors.initials: S
authors.lastname: Jochberger
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Werner
authors.initials: W
authors.lastname: Pajk
authors.forename: Hans
authors.initials: H
authors.lastname: Knotzer
authors.forename: Barbara
authors.initials: B
authors.lastname: Friesenecker
authors.forename: Karl
authors.initials: K
authors.lastname: Lindner
authors.forename: Walter
authors.initials: W
authors.lastname: Hasibeder
authors.forename: Martin
authors.initials: M
authors.lastname: Dünser
mesh_terms: D000368:Aged; D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000627:therapeutic use*; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007022:Hypotension / Q000188:drug therapy* / Q000503:physiopathology; D007262:Infusions, Intravenous; D007773:Lactates / Q000097:blood; D008297:Male; D020105:Milrinone / Q000008:administration & dosage; D009638:Norepinephrine / Q000008:administration & dosage; D012151:Resuscitation; D012189:Retrospective Studies
chemical_list: D007773:Lactates; D001127:Arginine Vasopressin; D020105:Milrinone; D001663:Bilirubin; D009638:Norepinephrine; D004837:Epinephrine