Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-27T02:52:51.875Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of Two Protocols for Pulseless Cardiopulmonary Arrest: Vasopressin Combined with Epinephrine Versus Epinephrine Alone

Published online by Cambridge University Press:  28 June 2012

Patrick Cody ,
Sean Lauderdale ,
David E. Hogan  and
Robert R. Frantz
Patrick Cody*
Affiliation:
Department of Emergency Medicine, Integris Southwest Medical Center, Emergency Medicine Residency Program, Prehospital and Disaster Medicine, Fellowship Program, Oklahoma City, Oklahoma, USA
Sean Lauderdale
Affiliation:
EMSStat Emergency Medical Services, Norman Regional Health System, Norman, Oklahoma, USA
David E. Hogan
Affiliation:
Department of Emergency Medicine, Integris Southwest Medical Center, Emergency Medicine Residency Program, Prehospital and Disaster Medicine, Fellowship Program, Oklahoma City, Oklahoma, USA
Robert R. Frantz
Affiliation:
EMSStat Emergency Medical Services, Norman Regional Health System, Norman, Oklahoma, USA Department of Emergency Medicine, Norman Regional Health System, Norman, Oklahoma, USA
*
Integris Southwest Medical Center, Emergency Medicine Residency Program, 4200 South Douglas #306, Oklahoma City, Oklahoma 73109 USA, E-mail: shogan4@cox.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Survival from pulseless cardiac arrest typically is dismal. Some suggest that adding vasopressin to epinephrine as a cardiovascular stimulant can improve outcomes.

Problem:

This study compares survival outcomes using epinephrine verses vasopressin and epinephrine in persons with pulseless cardiac arrest.

Methods:

This is a retrospective, cohort evaluation of two resuscitative protocols (P1-epinephrine or P2-vasopressin with epinephrine) in a tiered response, community emergency medical service (EMS) with an approximately 100,000 catchment area. Cases are defined as 18 years or older determined to be in pulseless cardiac arrest. Outcomes were survival to emergency department arrival, to 24 hours, and to hospital discharge. Data were entered into Microsoft Office Excel® and processed using Analyze-it® for continuous and categorical data and Epi-Info® for odds ratios with confidence intervals.

Results:

There were 204 cases (60.3% males and 39.7% females) who met the inclusion criteria. Thirteen cases received electrical therapy only, and were dropped from analysis, leaving 191 (93.6%) who were included in the study; P1 to 85 (44.5%) and P2 to 106 (55.5%). Younger age was associated with improved survival to discharge home in both protocols, p = 0.003 (95% CI = 0.004–0.010). No difference in survival was noted at the levels of emergency department arrival OR 1.42 (95% CI = 0.73, 2.76) p = 0.26; 24 hour survival OR 0.54 (95% CI = 0.22–1.30) p = 0.133, or discharge home OR = 1.81 (95% CI = 0.49–6.88) p = 0.319.

Conclusions:

This study in a community EMS did not demonstrate improved survival with the addition of vasopressin to epinephrine for pulseless cardiac arrest.

Keywords

cardiopulmonary arrestepinephrinevasopressin
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 5 , October 2010 , pp. 420 - 423
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

3.Wenzel, V, Raab, H, Dünser, MW: Role of arginine vasopressin in the setting of cardiopulmonary resuscitation. Best Pract Res Clin Anaesthesiol 2008;22(2):287–297.CrossRefGoogle ScholarPubMed
4.Zhong, J, Dorian, P: Epinephrine and vasopressin during cardiopulmonary resuscitation. Resuscitation 2005;66(3):263–269.CrossRefGoogle ScholarPubMed
5.Mulligan, KA, McKnite, SH, Lindner, KH, et al: Synergistic effects of vasopressin plus epinephrine during cardiopulmonary resuscitation. Resuscitation 1997;35:265–271.CrossRefGoogle ScholarPubMed
6.Stiell, IG, Herbert, PC, Wells, GA, et al: Vasopressin versus epinephrine for inhospital cardiac arrest: A randomized controlled trial. Lancet 2001;358:105–109.CrossRefGoogle Scholar
7.Lindner, KH, Prengel, AW, Brinkman, A, et al: Vasopressin administration in refractory cardiac arrest. Ann Intern Med 1996;124:1061–1064.CrossRefGoogle ScholarPubMed
8.Lindner, KH, Dirks, B, Strohmenger, HU, et al: A randomized comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet 1997;349:535–537.CrossRefGoogle ScholarPubMed
9.Wenzel, V, Lindner, KH, Augenstein, S, et al: Vasopressin combined with epinephrine decreases cerebral perfusion compared with vasopressin alone during cardiopulmonary resuscitation in pigs. Stroke 1998;29:1462–1468. [Editorial comment].CrossRefGoogle ScholarPubMed
10.Wayne, MA, Racht, EM, Aghababian, RV, et al: Prehospital management of cardiac arrest: How useful are vasopressor and antiarrhythmic drugs? Prehosp Emerg Care 2002;6:72–80.CrossRefGoogle ScholarPubMed
11.Berger, V: Selection Bias and Covariate Imbalances in Randomized Clinical Trials (Statistics in Practice). Hoboken: Wiley, 2005.CrossRefGoogle Scholar
12.Prengel, AW, Lindner, KH, Keller, A, et al: Cardiovascular function during the postresuscitation phase after cardiac arrest in pigs: A comparison of epinephrine versus vasopressin. Crit Care Med 1996;24(12):2014–2019.CrossRefGoogle ScholarPubMed
13.Stadlbauer, KH, Wagner-Berger, HG, Wenzel, V, et al: Survival with full neurologic recovery after prolonged cardiopulmonary resuscitation with a combination of vasopressin and epinephrine in pigs. Anesth Analg 2003;96:1743–1749.CrossRefGoogle ScholarPubMed
14.Mayr, VD, Wenzel, V, Voelckel, WG, et al: Developing a vasopressor combination in a pig model of adult asphyxial cardiac arrest. Circulation 2001;104:1651–1656.CrossRefGoogle Scholar
15.Prengel, AW, Lindner, KH, Keller, A: Cerebral oxygenation during cardiopulmonary resuscitation with epinephrine and vasopressin in pigs. Stroke 1996;27:1241–1248.CrossRefGoogle ScholarPubMed
16.Wenzel, V, Krismer, AC, Amtz, HR, et al: A comparison of vasopressin and epinepnrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 2004;350:105–113.CrossRefGoogle ScholarPubMed
17.Gueugniaud, PY, David, JS, Chanzey, E, et al: Vasopressin and epinephrine vs epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 2008;359:21–30.CrossRefGoogle ScholarPubMed