title: A randomised, double-blind, multi-centre trial comparing vasopressin and adrenaline in patients with cardiac arrest presenting to or in the Emergency Department.
abstract: OBJECTIVE
  To compare vasopressin and adrenaline in the treatment of patients with cardiac arrest presenting to or in the Emergency Department (ED).
  
  
  METHODS
  A randomised, double-blind, multi-centre, parallel-design clinical trial in four adult hospitals.
  
  
  METHODS
  Eligible cardiac arrest patients (confirmed by the absence of pulse, unresponsiveness and apnea) aged >16 (aged>21 for one hospital) were randomly assigned to intravenous adrenaline (1mg) or vasopressin (40 IU) at ED. Patients with traumatic cardiac arrest or contraindication for cardiopulmonary resuscitation (CPR) were excluded. Patients received additional open label doses of adrenaline as per current guidelines. Primary outcome was survival to hospital discharge (defined as participant discharged alive or survival to 30 days post-arrest).
  
  
  RESULTS
  The study recruited 727 participants (adrenaline = 353; vasopressin = 374). Baseline characteristics of the two groups were comparable. Eight participants (2.3%) from adrenaline and 11 (2.9%) from vasopressin group survived to hospital discharge with no significant difference between groups (p = 0.27, RR = 1.72, 95% CI = 0.65-4.51). After adjustment for race, medical history, bystander CPR and prior adrenaline given, more participants survived to hospital admission with vasopressin (22.2%) than with adrenaline (16.7%) (p = 0.05, RR = 1.43, 95% CI = 1.02-2.04). Sub-group analysis suggested improved outcomes for vasopressin in participants with prolonged arrest times.
  
  
  CONCLUSIONS
  Combination of vasopressin and adrenaline did not improve long term survival but seemed to improve survival to admission in patients with prolonged cardiac arrest. Further studies on the effect of vasopressin combined with therapeutic hypothermia on patients with prolonged cardiac arrest are needed.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. marcus.ong.e.h@sgh.com.sg
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
authors.forename: Ling
authors.initials: L
authors.lastname: Tiah
authors.forename: Benjamin Sieu-Hon
authors.initials: BS
authors.lastname: Leong
authors.forename: Elaine Ching Ching
authors.initials: EC
authors.lastname: Tan
authors.forename: Victor Yeok Kein
authors.initials: VY
authors.lastname: Ong
authors.forename: Elizabeth Ai Theng
authors.initials: EA
authors.lastname: Tan
authors.forename: Bee Yen
authors.initials: BY
authors.lastname: Poh
authors.forename: Pin Pin
authors.initials: PP
authors.lastname: Pek
authors.forename: Yuming
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine