Vasopressin Associated With an Increase in Return of Spontaneous Circulation in Acidotic Cardiopulmonary Arrest Patients

Turner, DeAnna W.; Attridge, Rebecca L.; Hughes, Daniel C.

doi:10.1177/1060028014537037

Cited by 15 publications

(12 citation statements)

References 22 publications

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“…In comparison with adrenaline it has a longer half-life (10-20 min vs. 4 min) and it is potentially more effective during acidosis. 656,657 Vasopressin has been proposed as an alternative to adrenaline in cardiac arrest, based on the finding that its levels were significantly higher in successfully resuscitated patients than in patients who died. 658 However, a trial comparing up to four doses of either 40 IU vasopressin or 1 mg adrenaline every 5-10 min in patients with out of hospital cardiac arrest did not demonstrate any significant difference in terms of survival to hospital discharge or neurological outcome between the two study arms.…”

Section: Adrenaline (Epinephrine) Versus Vasopressinmentioning

confidence: 99%

European Resuscitation Council Guidelines for Resuscitation 2015

et al. 2015

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These Guidelines are based on the International Liaison Committee on Resuscitation (ILCOR) 2015 Consensus on Science and Treatment Recommendations (CoSTR) for ALS. 4 The 2015 ILCOR review focused on 42 topics organised in the approximate sequence of ALS interventions: defibrillation, airway, oxygenation and ventilation, circulatory support, monitoring during CPR, and drugs during CPR. For these Guidelines the ILCOR recommendations were supplemented by focused literature reviews undertaken by the ERC ALS Writing Group for those topics not reviewed in the 2015 ILCOR CoSTR. Guidelines were drafted and agreed by the ALS Writing Group members before final approval by the ERC General Assembly and ERC Board. Summary of changes since 2010 GuidelinesThe 2015 ERC ALS Guidelines have a change in emphasis aimed at improved care and implementation of these guidelines in order to improve patient focused outcomes. 5 The 2015 ERC ALS Guidelines do not include any major changes in core ALS interventions since the previous ERC guidelines published in 2010. 1,2 The key changes since 2010 are:• Continuing emphasis on the use of rapid response systems for care of the deteriorating patient and prevention of in-hospital cardiac arrest. • Continued emphasis on minimally interrupted high-quality chest compressions throughout any ALS intervention: chest

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Section: Adrenaline (Epinephrine) Versus Vasopressinmentioning

confidence: 99%

European Resuscitation Council Guidelines for Resuscitation 2015

et al. 2015

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“…While the main focus of previous trials was universal administration of vasopressin during resuscitation, the key goal of this trial is to assess the effects of augmentation of vasopressin to improve the outcome among patients with cardiac arrest who do not maintain diastolic blood pressure above 20 mmHg only. Because diastolic pressure is associated with coronary perfusion pressure and vasopressin is another vasopressor which has different mechanism from epinephrine 22 . Therefore, for the patients who is severe vasoplegic state during CPR, vasopressin may have a synergic effect with epinephrine.…”

Section: Discussionmentioning

confidence: 99%

“…While the main focus of previous trials was universal administration of vasopressin during resuscitation, the key goal of this trial was to assess the effects of vasopressin on outcomes only among patients with cardiac arrest who cannot maintain diastolic blood pressure above 20 mmHg. Because vasopressin is another vasopressor which has a different mechanism from epinephrine, it may have a synergic effect with epinephrine for the patients in a severe vasoplegic state during CPR [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Augmented-Medication CardioPulmonary Resuscitation (AMCPR) trial: a study protocol for a randomized controlled trial

Kim

Ryoo

et al. 2022

Clin Exp Emerg Med

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Background: Because most previous studies about the usefulness of vasopressin during resuscitation had been physician-oriented, it is necessary to evaluate with patient-centered. The aim of this study is to investigate whether Augmented-Medication CardioPulmonary Resuscitation (AMCPR) would enhance chance to return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest.Methods: This is a double-blind, single-center, randomized placebo-controlled trial conducted in the emergency department in tertiary, university-affiliated hospital in Seoul, Korea. A total of 148 adult patients with non-traumatic, non-shockable, out-of-hospital cardiac arrest those who have initial diastolic blood pressure above 20 mmHg will be randomly assigned to two groups of 74 patients (1:1 ratio). Patients will receive intravenously a dose of 40 IU of vasopressin with epinephrine, or a placebo with epinephrine. The primary endpoint is a sustained ROSC (over 20 minutes). Secondary endpoints are enhancing diastolic blood pressures, end-tidal carbon dioxide levels, acidosis, and lactate levels during resuscitation.Discussion: AMCPR is a trial about tailor made medication for selected patients during resuscitation. This is a first randomized control trial to find patients who will be help to ROSC by vasopressin. This study will provide evidence about the effect of additional administration of vasopressin with epinephrine to increase the ROSC rate.

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“…Through β-adrenergic receptor stimulation, epinephrine increases myocardial oxygen demands, respiratory and metabolic acidosis (common during neonatal asphyxia), and inhibits hemodynamic responses (e.g., aggravated hypertension or tachycardia after ROSC) [15]. Increased myocardial oxygen demand could delay ROSC and potentially lead to brain damage if hypoxia persists [16,17].…”

Section: Adverse Effectsmentioning

confidence: 99%

Cardiac Agents during Neonatal Cardiopulmonary Resuscitation

Ramsie,

Cheung,

O’Reilly

et al. 2024

Neonatology

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Background: Epinephrine (adrenaline) is currently the only cardiac agent recommended during neonatal resuscitation. The inability to predict which newborns are at risk of requiring resuscitative efforts at birth has prevented the collection of large, high-quality human data. Summary: Information on the optimal dosage and route of epinephrine administration is extrapolated from neonatal animal studies and human adult and pediatric studies. Adult resuscitation guidelines have previously recommended vasopressin use; however, neonatal studies needed to create guidelines are lacking. A review of the literature demonstrates conflicting results regarding epinephrine efficacy through various routes of access as well as vasopressin during asystolic cardiac arrest in animal models. Vasopressin appears to improve hemodynamic and post-resuscitation outcomes compared to epinephrine in asystolic cardiac arrest animal models. Key Messages: The current neonatal resuscitation guidelines recommend epinephrine be primarily given via the intravenous or intraosseous route, with the endotracheal route as an alternative if these routes are not feasible or unsuccessful. The intravenous or intraosseous dose ranges between 0.01 and 0.03 mg/kg, which should be repeated every 3–5 min during chest compressions. However, the optimal dosing and route of administration of epinephrine remain unknown. There is evidence from adult and pediatric studies that vasopressin might be an alternative to epinephrine; however, the neonatal data are scarce.

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Vasopressin Associated With an Increase in Return of Spontaneous Circulation in Acidotic Cardiopulmonary Arrest Patients

Abstract: Vasopressin in combination with epinephrine demonstrated improved ROSC in cardiac arrest patients with initial arterial pH <7.2 compared with epinephrine alone, without improving survival to hospital discharge.

Cited by 15 publications

References 22 publications

European Resuscitation Council Guidelines for Resuscitation 2015

European Resuscitation Council Guidelines for Resuscitation 2015

Augmented-Medication CardioPulmonary Resuscitation (AMCPR) trial: a study protocol for a randomized controlled trial

Cardiac Agents during Neonatal Cardiopulmonary Resuscitation

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