title: Vasopressin rescue for in-pediatric intensive care unit cardiopulmonary arrest refractory to initial epinephrine dosing: a prospective feasibility pilot trial.
abstract: OBJECTIVE
  To assess the feasibility of a large, randomized controlled trial of combination epinephrine-arginine vasopressin for in-pediatric intensive care unit cardiopulmonary arrest refractory to initial epinephrine dosing.
  
  
  METHODS
  Prospective, pilot, matched controlled clinical trial using exception from informed consent.
  
  
  METHODS
  Pediatric intensive care unit in a university-affiliated tertiary care children's hospital.
  
  
  METHODS
  All patients <18 yrs of age admitted to the pediatric intensive care unit with cardiopulmonary arrest requiring chest compressions and epinephrine (0.01 mg/kg) were eligible.
  
  
  METHODS
  Patients who remained in cardiopulmonary arrest despite an initial dose of epinephrine received arginine vasopressin (0.8 U/kg) rescue as the second vasopressor, followed by additional epinephrine if needed.
  
  
  RESULTS
  Outcome variables included return of spontaneous circulation (≥20 min), survival at 24 hrs, survival to hospital discharge, and neurologic status at discharge. Favorable neurologic status was defined as Pediatric Cerebral Performance Categories 1, 2, and 3, or no change from admission. Data were compared to a retrospective, matched cohort of patients who experienced cardiopulmonary arrest requiring ≥ two doses of vasopressor, and did not receive arginine vasopressin (n = 20). Of 2,654 patients admitted to the pediatric intensive care unit, 29 (1.1%) had refractory cardiopulmonary arrest: five patients were excluded, 14 missed for inclusion, and ten were enrolled. There was increased 24-hr survival (80% vs. 30%, odds ratio 9.33, 95% confidence interval 1.51-57.65) in arginine vasopressin patients. There was no significant difference in return of spontaneous circulation, survival to hospital discharge, or favorable neurologic status at discharge.
  
  
  CONCLUSIONS
  These pilot data provide support for a larger randomized controlled trial of arginine vasopressin therapy during cardiopulmonary resuscitation for in-hospital pediatric cardiac arrest.
authors.affiliation: Department of Pediatrics, Division of Critical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Carroll
authors.forename: Vivian V
authors.initials: VV
authors.lastname: Dimas
authors.forename: Tia Tortoriello
authors.initials: TT
authors.lastname: Raymond
mesh_terms: D001127:Arginine Vasopressin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D004837:Epinephrine