Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation.
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.)
Gueugniaud
Pierre-Yves
PY
Service d'Aide Médicale Urgente 69, Hospices Civils de Lyon, University of Lyon 1, Lyon, France. pierre-yves.gueugniaud@chu-lyon.fr
David
Jean-Stéphane
JS
Chanzy
Eric
E
Hubert
Hervé
H
Dubien
Pierre-Yves
PY
Mauriaucourt
Patrick
P
Bragança
Coralie
C
Billères
Xavier
X
Clotteau-Lambert
Marie-Paule
MP
Fuster
Patrick
P
Thiercelin
Didier
D
Debaty
Guillaume
G
Ricard-Hibon
Agnès
A
Roux
Patrick
P
Espesson
Catherine
C
Querellou
Emgan
E
Ducros
Laurent
L
Ecollan
Patrick
P
Halbout
Laurent
L
Savary
Dominique
D
Guillaumée
Frédéric
F
Maupoint
Régine
R
Capelle
Philippe
P
Bracq
Cécile
C
Dreyfus
Philippe
P
Nouguier
Philippe
P
Gache
Antoine
A
Meurisse
Claude
C
Boulanger
Bertrand
B
Lae
Claude
C
Metzger
Jacques
J
Raphael
Valérie
V
Beruben
Arielle
A
Wenzel
Volker
V
Guinhouya
Comlavi
C
Vilhelm
Christian
C
Marret
Emmanuel
E
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*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine