title: Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation.
abstract: BACKGROUND
  During the administration of advanced cardiac life support for resuscitation from cardiac arrest, a combination of vasopressin and epinephrine may be more effective than epinephrine or vasopressin alone, but evidence is insufficient to make clinical recommendations.
  
  
  METHODS
  In a multicenter study, we randomly assigned adults with out-of-hospital cardiac arrest to receive successive injections of either 1 mg of epinephrine and 40 IU of vasopressin or 1 mg of epinephrine and saline placebo, followed by administration of the same combination of study drugs if spontaneous circulation was not restored and subsequently by additional epinephrine if needed. The primary end point was survival to hospital admission; the secondary end points were return of spontaneous circulation, survival to hospital discharge, good neurologic recovery, and 1-year survival.
  
  
  RESULTS
  A total of 1442 patients were assigned to receive a combination of epinephrine and vasopressin, and 1452 to receive epinephrine alone. The treatment groups had similar baseline characteristics except that there were more men in the group receiving combination therapy than in the group receiving epinephrine alone (P=0.03). There were no significant differences between the combination-therapy and the epinephrine-only groups in survival to hospital admission (20.7% vs. 21.3%; relative risk of death, 1.01; 95% confidence interval [CI], 0.97 to 1.05), return of spontaneous circulation (28.6% vs. 29.5%; relative risk, 1.01; 95% CI, 0.97 to 1.06), survival to hospital discharge (1.7% vs. 2.3%; relative risk, 1.01; 95% CI, 1.00 to 1.02), 1-year survival (1.3% vs. 2.1%; relative risk, 1.01; 95% CI, 1.00 to 1.02), or good neurologic recovery at hospital discharge (37.5% vs. 51.5%; relative risk, 1.29; 95% CI, 0.81 to 2.06).
  
  
  CONCLUSIONS
  As compared with epinephrine alone, the combination of vasopressin and epinephrine during advanced cardiac life support for out-of-hospital cardiac arrest does not improve outcome. (ClinicalTrials.gov number, NCT00127907.)
authors.affiliation: Service d'Aide Médicale Urgente 69, Hospices Civils de Lyon, University of Lyon 1, Lyon, France. pierre-yves.gueugniaud@chu-lyon.fr
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Gueugniaud
authors.forename: Jean-Stéphane
authors.initials: JS
authors.lastname: David
authors.forename: Eric
authors.initials: E
authors.lastname: Chanzy
authors.forename: Hervé
authors.initials: H
authors.lastname: Hubert
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Dubien
authors.forename: Patrick
authors.initials: P
authors.lastname: Mauriaucourt
authors.forename: Coralie
authors.initials: C
authors.lastname: Bragança
authors.forename: Xavier
authors.initials: X
authors.lastname: Billères
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Clotteau-Lambert
authors.forename: Patrick
authors.initials: P
authors.lastname: Fuster
authors.forename: Didier
authors.initials: D
authors.lastname: Thiercelin
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.forename: Agnès
authors.initials: A
authors.lastname: Ricard-Hibon
authors.forename: Patrick
authors.initials: P
authors.lastname: Roux
authors.forename: Catherine
authors.initials: C
authors.lastname: Espesson
authors.forename: Emgan
authors.initials: E
authors.lastname: Querellou
authors.forename: Laurent
authors.initials: L
authors.lastname: Ducros
authors.forename: Patrick
authors.initials: P
authors.lastname: Ecollan
authors.forename: Laurent
authors.initials: L
authors.lastname: Halbout
authors.forename: Dominique
authors.initials: D
authors.lastname: Savary
authors.forename: Frédéric
authors.initials: F
authors.lastname: Guillaumée
authors.forename: Régine
authors.initials: R
authors.lastname: Maupoint
authors.forename: Philippe
authors.initials: P
authors.lastname: Capelle
authors.forename: Cécile
authors.initials: C
authors.lastname: Bracq
authors.forename: Philippe
authors.initials: P
authors.lastname: Dreyfus
authors.forename: Philippe
authors.initials: P
authors.lastname: Nouguier
authors.forename: Antoine
authors.initials: A
authors.lastname: Gache
authors.forename: Claude
authors.initials: C
authors.lastname: Meurisse
authors.forename: Bertrand
authors.initials: B
authors.lastname: Boulanger
authors.forename: Claude
authors.initials: C
authors.lastname: Lae
authors.forename: Jacques
authors.initials: J
authors.lastname: Metzger
authors.forename: Valérie
authors.initials: V
authors.lastname: Raphael
authors.forename: Arielle
authors.initials: A
authors.lastname: Beruben
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Comlavi
authors.initials: C
authors.lastname: Guinhouya
authors.forename: Christian
authors.initials: C
authors.lastname: Vilhelm
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marret
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services / Q000458:organization & administration; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine