P Rehospital M Anagement of C Ardiac a Rrest : H Ow U Seful a Re v Asopressor and a Ntiarrhythmic D Rugs ?

Abstract

Out-of-hospital resuscitation protocols for patients suffering cardiac arrest have historically included cardiopulmonary resuscitation, defibrillation, and rapid transport to a hospital. For many years, use of drugs to improve myocardial perfusion or to correct arrhythmias that occur during cardiac arrest has been part of prehospital efforts to revive patients in ventricular tachycardia or ventricular fibrillation. Use of some of these drugs, however, may be based more on tradition than on well-documented evidence of efficacy. The authors reviewed pertinent data on the vasopressors epinephrine and vasopressin and the antiarrhythmics amiodarone and lidocaine to evaluate the usefulness of these drugs in cardiac arrest. They found little clinical data supporting the prehospital use of lidocaine in cardiac arrest, and despite a great deal of laboratory and clinical data addressing the efficacy of epinephrine, there is no large, randomized, controlled clinical trial supporting its use. Data on amiodarone and vasopressin support the use of these drugs in out-of-hospital resuscitation efforts.

Vasopressin and epinephrine in the treatment of cardiac arrest: an experimental study

“…Via the V 2 receptors, vasopressin possibly induces vasodilation [ 21 - 23 ]. Unlike epinephrine, it is resistant to the effects of acidosis [ 24 , 25 ]. Endogenous vasopressin levels were found to be higher in survivors of cardiac arrest than those who died [ 26 - 28 ].…”

Emergency medical services in Japan: An opportunity for the rational development of pre-hospital care and research

“…By expensive, it is meant threefold: in economic, social and professional terms. By controversial, we mean that many of the general practices of pre-hospital ACLS and BTLS, although appealing and empirically useful, have not necessarily been proven effective by prospective studies and, at this time, the most rigorous data are lacking (5,6,(23)(24)(25)(26)(27)(28)(29)(30)(31). Thus, in the United States and in North America in general, there are 30 to 50 protocols for any paramedic to choose from in any given situation-many of which probably do not require attention in the span of an ambulance's arrival and delivery of the patient to an ED, especially in an urban setting with short transport times.…”

“…Many arguments have been put forth suggesting that endotracheal intubation, vasopressors and antidysrhythmics, applied in certain pre-hospital settings, may save lives (36,37). These interventions deserve the most rigorous scrutiny and testing (25).…”

Vasopressin and epinephrine versus epinephrine in management of patients with cardiac arrest: a meta-analysis

“…(13)(14)(15)(16)(17) It may cause severe tachycardia immediately after ROSC, (18,19) and the most serious side effect of epinephrine is the increase in myocardial oxygen consumption during VF and myocardial dysfunction in the post-resuscitation phase. (20) The recently published European Resuscitation Council CPR Guidelines state that 'current evidence is insufficient to support or refute the routine use of any particular drug or sequence of drugs'; the respective CPR algorithm primarily recommends injection of 1 mg epinephrine every 3-5 minutes, while vasopressin may also be injected.…”