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Vasopressin Not Helpful for Out-of-Hospital Cardiac Arrest

For now, epinephrine remains the only evidence-based drug option in CPR.

The ideal drug regimen for use in CPR is a subject of controversy. Epinephrine is the recommended vasopressor agent, but results of some studies suggest that combining epinephrine with vasopressin, a peptide involved in regulating fluid volume, may confer additional benefit. Current guidelines do not endorse the use of vasopressin in CPR.

Investigators analyzed data on 2894 patients in France who experienced out-of-hospital cardiac arrest and were randomized to receive successive injections of 1 mg of epinephrine and either 40 IU of vasopressin or saline placebo. The primary outcome was survival to hospital admission. The average patient age was about 62, and about three quarters of the events were witnessed. The mean time from collapse to arrival of emergency personnel was 7 minutes, and the mean time from collapse to injection of study drug was 21 minutes. Automated external defibrillation was administered to about 80% of patients. The primary endpoint did not differ significantly between the combination-therapy group and the epinephrine-only group (20.7% vs. 21.3%). There were also no significant between-group differences in rates of return of spontaneous circulation (28.6% vs. 29.5%), survival to hospital discharge (1.7% vs. 2.3%), or 1-year survival (1.3% vs. 2.1%).

Comment: This study tested a new drug strategy for out-of-hospital cardiac arrest, which failed to improve upon epinephrine, the agent currently recommended in guidelines. What I find striking about these results is how poorly these patients continue to fare.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology 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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