Vasopressin and epinephrine for cardiac arrest

Stiell, Ian G.; Hébert, Paul; Wells, George

doi:10.1016/s0140-6736(01)07113-6

Cited by 2 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…response times are short. [59] In another clinical evaluation in MichThese results did not confirm earlier data suggesting that vasoigan, 4 of 10 patients responded to vasopressin administration after pressin was more effective than epinephrine as a first-line vaso-×45 minutes of unsuccessful advanced cardiac life support, and pressor drug in the treatment of ventricular fibrillation and pulsehad a mean increase in coronary perfusion pressure of 28mm less electrical activity. [45][46][47]51,55,57] Criticism has been raised that Hg.…”

Section: In Clinical Studiesmentioning

confidence: 90%

See 1 more Smart Citation

Vasopressin During Cardiopulmonary Resuscitation and Different Shock States

Krismer

Dünser

Lindner

et al. 2006

American Journal of Cardiovascular Drugs

View full text Add to dashboard Cite

Vasopressin administration may be a promising therapy in the management of various shock states. In laboratory models of cardiac arrest, vasopressin improved vital organ blood flow, cerebral oxygen delivery, the rate of return of spontaneous circulation, and neurological recovery compared with epinephrine (adrenaline). In a study of 1219 adult patients with cardiac arrest, the effects of vasopressin were similar to those of epinephrine in the management of ventricular fibrillation and pulseless electrical activity; however, vasopressin was superior to epinephrine in patients with asystole. Furthermore, vasopressin followed by epinephrine resulted in significantly higher rates of survival to hospital admission and hospital discharge. The current cardiopulmonary resuscitation guidelines recommend intravenous vasopressin 40 IU or epinephrine 1mg in adult patients refractory to electrical countershock. Several investigations have demonstrated that vasopressin can successfully stabilize hemodynamic variables in advanced vasodilatory shock. Use of vasopressin in vasodilatory shock should be guided by strict hemodynamic indications, such as hypotension despite norepinephrine (noradrenaline) dosages >0.5 mug/kg/min. Vasopressin must never be used as the sole vasopressor agent. In our institutional routine, a fixed vasopressin dosage of 0.067 IU/min (i.e. 100 IU/50 mL at 2 mL/h) is administered and mean arterial pressure is regulated by adjusting norepinephrine infusion. When norepinephrine dosages decrease to 0.2 microg/kg/min, vasopressin is withdrawn in small steps according to the response in mean arterial pressure. Vasopressin also improved short- and long-term survival in various porcine models of uncontrolled hemorrhagic shock. In the clinical setting, we observed positive effects of vasopressin in some patients with life-threatening hemorrhagic shock, which had no longer responded to adrenergic catecholamines and fluid resuscitation. Clinical employment of vasopressin during hemorrhagic shock is experimental at this point in time.

show abstract

Section: In Clinical Studiesmentioning

confidence: 90%

“…In a recent in-hospital CPR study [59] reporting comparable post hoc observation should be tested in a prospective trial restricteffects of vasopressin and epinephrine, 87% of vasopressin-treated ed to such patients for whom few treatment options are available.…”

Section: In Clinical Studiesmentioning

confidence: 99%

Vasopressin During Cardiopulmonary Resuscitation and Different Shock States

Krismer

Dünser

Lindner

et al. 2006

American Journal of Cardiovascular Drugs

View full text Add to dashboard Cite

show abstract

“…Patients who did not respond to the first injection were then given epinephrine as a rescue medication. No significant differences in survival to hospital discharge, 1‐hour survival, or mental state examination scores were identified 74 . Possible explanation for the lack of significant differences could be a greater comorbidity of various chronic illness 74 within this patient population or that epinephrine and AVP are equipotent when rescue times are short 75 .…”

mentioning

confidence: 80%

“…No significant differences in survival to hospital discharge, 1‐hour survival, or mental state examination scores were identified 74 . Possible explanation for the lack of significant differences could be a greater comorbidity of various chronic illness 74 within this patient population or that epinephrine and AVP are equipotent when rescue times are short 75 . In a prospective, double blinded, controlled, multicenter European study, 1,186 patients were randomized to receive either 2 injections of AVP (40 U) or epinephrine (1 mg) for out‐of‐hospital cardiopulmonary arrest 76 .…”

mentioning

confidence: 89%

“…Four studies, because of study design and patient numbers, provide the most accurate information regarding the effect of AVP on cardiopulmonary arrest. A randomized, placebo‐controlled study of 200 patients with in‐house cardiopulmonary arrest was used to compare AVP and epinephrine 74 . In that study, patients were assigned to either receive AVP (40 U) or epinephrine (1 mg).…”

mentioning

confidence: 99%

See 1 more Smart Citation

The use of vasopressin for treating vasodilatory shock and cardiopulmonary arrest

Scroggin¹,

Quandt

2009

J Vet Emergen Crit Care

View full text Add to dashboard Cite

Objective -To discuss 3 potential mechanisms for loss of peripheral vasomotor tone during vasodilatory shock; review vasopressin physiology; review the available animal experimental and human clinical studies of vasopressin in vasodilatory shock and cardiopulmonary arrest; and make recommendations based on review of the data for the use of vasopressin in vasodilatory shock and cardiopulmonary arrest. Data Sources -Human clinical studies, veterinary experimental studies, forum proceedings, book chapters, and American Heart Association guidelines. Human and Veterinary Data Synthesis -Septic shock is the most common form of vasodilatory shock. The exogenous administration of vasopressin in animal models of fluid-resuscitated septic and hemorrhagic shock significantly increases mean arterial pressure and improves survival. The effect of vasopressin on return to spontaneous circulation, initial cardiac rhythm, and survival compared with epinephrine is mixed. Improved survival in human patients with ventricular fibrillation, pulseless ventricular tachycardia, and nonspecific cardiopulmonary arrest has been observed in 4 small studies of vasopressin versus epinephrine. Three large studies, though, did not find a significant difference between vasopressin and epinephrine in patients with cardiopulmonary arrest regardless of initial cardiac rhythm. No veterinary clinical trials have been performed using vasopressin in cardiopulmonary arrest. Conclusion -Vasopressin (0.01-0.04 U/min, IV) should be considered in small animal veterinary patients with vasodilatory shock that is unresponsive to fluid resuscitation and catecholamine (dobutamine, dopamine, and norepinephrine) administration. Vasopressin (0.2-0.8 U/kg, IV once) administration during cardiopulmonary resuscitation in small animal veterinary patients with pulseless electrical activity or ventricular asystole may be beneficial for myocardial and cerebral blood flow.

show abstract

Vasopressin and epinephrine for cardiac arrest

Cited by 2 publications

References 0 publications

Vasopressin During Cardiopulmonary Resuscitation and Different Shock States

Vasopressin During Cardiopulmonary Resuscitation and Different Shock States

The use of vasopressin for treating vasodilatory shock and cardiopulmonary arrest

Contact Info

Product

Resources

About