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35 - Vasopressin and other non-adrenergic vasopressors

from Part IV - Therapy of sudden death

Published online by Cambridge University Press:  06 January 2010

Anette C. Krismer
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
Martin Dunser
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
Karl H. Stadlbauer
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
Karl H. Lindner
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
Volker Wenzel
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
Norman A. Paradis
Affiliation:
University of Colorado, Denver
Henry R. Halperin
Affiliation:
The Johns Hopkins University School of Medicine
Karl B. Kern
Affiliation:
University of Arizona
Volker Wenzel
Affiliation:
Medizinische Universität Innsbruck, Austria
Douglas A. Chamberlain
Affiliation:
Cardiff University
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Summary

Basic science

The importance of arterial vascular tone in resuscitation from cardiac arrest has been described in detail in the previous chapters of this book.

Efficacy of non-adrenergic pressors

There is a longstanding concern that administration of adrenaline during resuscitation may result in detrimental effects during the postresuscitation period. Forexample, laboratory studies with adrenaline during cardiopulmonary resuscitation (CPR) showed increased myocardial oxygen consumption, ventricular arrhythmias, ventilation–perfusion defects, and postresuscitation myocardial dysfunction. Therefore, non-adrenergic vasoactive peptides such as vasopressin hold considerable promise, since theymayraise perfusion pressure without the β-receptor-mediated side effects of adrenergic vasopressors. Another intriguing possibility is that they may act synergistically when administered together with catecholamines, and that concomitant use of adrenergic drugs and nonadrenergic vasoactive peptides may allow lowering of the dose of each agent.

Vasopressin, an endogenous stress hormone

A number of fundamental endocrine responses of the human body to cardiac arrest and CPR have been investigated in past years, and are summarized in another chapter of this book. Circulating endogenous vasopressin concentrations were high in patients undergoing CPR, and levels in successfully resuscitated patients have been shown to be significantly higher than those in patients who died. This may indicate that the human body discharges vasopressin as an adjunct endogenous vasopressor to epinephrine in life-threatening situations such as cardiac arrest in order to preserve homeostasis. In a clinical study of 60 out-of-hospital cardiac arrest patients, parallel increases in plasma vasopressin and endothelin during CPR were found only in surviving patients. Thus, plasma concentrations of vasopressin may have a more important effect on CPR outcome than was previously thought. These observations prompted several investigations to assess the role of arginine vasopressin in the management of CPR in order to improve patient outcome.

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Information
Cardiac Arrest
The Science and Practice of Resuscitation Medicine
, pp. 647 - 666
Publisher: Cambridge University Press
Print publication year: 2007

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