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Vasopressin Adds No Benefit to Epinephrine in Cardiac Arrest
Defibrillation and chest compressions remain key to survival.
Animal studies and small human studies have provided preliminary evidence that adding vasopressin to the standard advanced cardiac life support (ACLS) drug regimen improves survival after cardiac arrest. However, this evidence had not been validated in a large, randomized, placebo-controlled trial.
In a multicenter study, researchers in France randomized 2894 patients with out-of-hospital cardiac arrest to receive epinephrine (1 mg) plus either placebo or vasopressin (40 IU) after three failed attempts at defibrillation. The assigned drug regimen was repeated after 3 minutes if spontaneous circulation was not restored, and open-label epinephrine was administered at the discretion of the treating physician if after another 3 minutes spontaneous circulation still was not restored.
The primary endpoint was survival to hospital admission (defined as admission of a patient with measurable blood pressure and palpable pulse to an intensive care unit). Secondary endpoints included survival to hospital discharge, neurologic status at discharge, and 1-year survival. Rates of the primary endpoint and all secondary endpoints did not differ between the vasopressin and control groups. Patients were significantly more likely to survive to hospital admission if their arrests were witnessed than if their arrests were unwitnessed. Patients also were more likely to survive to hospital admission if they received basic life support (BLS) within 8 minutes and ACLS within 12 minutes after arrest than if they received BLS and ACLS later.
Comment: In this large study with few protocol violations, the finding is unequivocally definitive: Vasopressin has no benefit in cardiac arrest. Early shock therapy and rapid chest compressions as specified in the current BLS protocols offer the best chance for survival.
— J. Stephen Bohan, MD, MS, FACP, FACEP
Published in Journal Watch Emergency Medicine July 2, 2008
Citation(s):
Gueugniaud P-Y et al. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 2008 Jul 3; 359:21.
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