Is the combination of vasopressin and epinephrine superior to repeated doses of epinephrine alone in the treatment of cardiac arrest—A systematic review

Sillberg, Victoria A.H.; Perry, Jeffrey J.; Stiell, Ian G.; Wells, George A.

doi:10.1016/j.resuscitation.2008.07.020

Cited by 18 publications

(5 citation statements)

References 22 publications

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“…3 Among cities reporting data, the median rate of survival to hospital discharge is 6.4%. 4 Previous meta-analyses of cardiac arrest research have focused on the use of new or emerging therapies (ie, impedance threshold device, 5 active compression-decompression cardiopulmonary resuscitation, 6 hypothermia, 7 emergency intubation 8 ), new medications (ie, vasopressin, 9 -11 epinephrine, 11,12 time to first medication administration 13 ), and the use of automated external defibrillators by bystanders 14 -16 and emergency medical technicians. 4,17 However, no group has conducted a systematic review to assess, with precision, the associations between key clinical factors and survival, and examine temporal trends in OHCA survival through the decades.…”

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confidence: 99%

Predictors of Survival From Out-of-Hospital Cardiac Arrest

Sasson

Rogers

Dahl

et al. 2010

Circ: Cardiovascular Quality and Outcomes

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1,159

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confidence: 99%

Predictors of Survival From Out-of-Hospital Cardiac Arrest

Sasson

Rogers

Dahl

et al. 2010

Circ: Cardiovascular Quality and Outcomes

1,822

1,159

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“…Nevertheless, this result was not confirmed for more long-term outcomes. 35 Mentzelopoulos et al found the adrenaline/vasopressine combination to be significantly superior to adrenaline alone for both ROSC incidence and survival to hospital discharge in asystolic CA. Furthermore, they also found that vasopressin might have better long-term outcomes than adrenaline when drugs were administered within 20 minutes of CA.…”

Section: Resultsmentioning

confidence: 99%

Drug use during adult advanced cardiac life support: An overview of reviews

Vandersmissen

Gworek²,

Dewolf³

et al. 2021

Resuscitation Plus

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Aim To conduct an overview of systematic reviews and meta-analyses to summarize the ever-growing evidence on drug use during advanced life support. Methods We searched Embase, Medline, Cochrane central register of controlled trials and Web of science for systematic reviews and meta-analyses reporting on drug use during advanced life support from inception to March, 2020. Two reviewers independently assessed all abstracts for eligibility, extracted data and assessed risk of bias using the AMSTAR-2 tool. Corrected covered areas were calculated from publication citation matrices to account for potential risk of bias. Data were graphically represented using forest plots. Results Twenty-two head-to-head drug comparisons from 47 included articles were analysed. Adrenaline significantly increases the incidence of return of spontaneous circulation and survival to hospital discharge, but not the incidence of neurological intact survival. Vasopressin alone or in combination with adrenaline is not superior to adrenaline alone. There is a trend favouring lidocaine over amiodarone in shockable cardiac arrest. The risk of bias assessment of included studies ranged from very low to very high and the overlap between articles was moderate to high. Conclusions In line with the guidelines, we currently suggest that a standard dose of adrenaline should be administered during resuscitation, however, studies assessing lower doses of adrenaline are pressing. There is no rationale for the combination of vasopressin and adrenaline or vasopressin alone instead of adrenaline. In addition, lidocaine is a valuable alternative for amiodarone and maybe even preferable for shockable cardiac arrest. However more research is necessary.

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“…Additionally, the benefits of vasopressin administration, alone or when combined with epinephrine, in clinical cardiac arrest have yielded equivocal results 11. However, these clinical trials have not included chronic adrenergic blocker therapy as a pre-arrest variable during the course of data and outcome analysis.…”

Section: Discussionmentioning

confidence: 99%

Does prearrest adrenergic integrity affect pressor response? A comparison of epinephrine and vasopressin in a spontaneous ventricular fibrillation swine model

et al. 2011

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Objectives-Coronary perfusion pressure (CPP) during resuscitation from cardiac arrest has been shown to correlate with return of spontaneous circulation. Adrenergic blockade of beta-1 and alpha-1 receptors is common in the long-term management of ischemic heart disease and congestive heart failure. We sought to compare the CPP response to vasopressin vs. epinephrine in a swine model of cardiac arrest following pre-arrest adrenergic blockade.Methods-Eight anesthetized and instrumented swine were administered 0.1 mg epinephrine and arterial pressure and heart rate response were measured. An infusion of labetalol was then initiated and animals periodically challenged with epinephrine until adrenergic blockade was confirmed. The left anterior descending coronary artery was occluded to produce ventricular fibrillation (VF). After 7 minutes of untreated VF, mechanical chest compressions were initiated. After 1 minute of compressions, 1 mg epinephrine was given while CPP was recorded. When CPP values had returned to pre-epinephrine levels, 40 U of bolus vasopressin was given. Differences in CPP (postvasopressor -pre-vasopressor) were compared within animals for the epinephrine and vasopressin response and with eight, non-adrenergically blocked, historical controls using Bayesian statistics with a non-informative prior.Address for correspondence: Scott T. Youngquist, MD, MSc, University of Utah, Division of Emergency Medicine, 30 North 1900 East, Room 1C026, Salt Lake City, UT 84132, scott.youngquist@utah.edu, Phone: 801-581-2730. Conflict of interest statement None to declare.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptResuscitation. Author manuscript; available in PMC 2012 February 1. Results-The CPP response following epinephrine was 15.1 mmHg lower in adrenergicallyblocked animals compared to non-adrenergically blocked animals (95% Highest Posterior Density [HPD] 2.9 -27.2 mmHg lower). CPP went up 18.4 mmHg more following vasopressin when compared to epinephrine (95% HPD 8.2 -29.1 mmHg). The posterior probability of a higher CPP response from vasopressin (vs. epinephrine) in these animals was 0.999.Conclusions-Pre-arrest adrenergic blockade blunts the CPP response to epinephrine. Superior augmentation of CPP is attained with vasopressin under these conditions.

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Is the combination of vasopressin and epinephrine superior to repeated doses of epinephrine alone in the treatment of cardiac arrest—A systematic review

Cited by 18 publications

References 22 publications

Predictors of Survival From Out-of-Hospital Cardiac Arrest

Predictors of Survival From Out-of-Hospital Cardiac Arrest

Drug use during adult advanced cardiac life support: An overview of reviews

Does prearrest adrenergic integrity affect pressor response? A comparison of epinephrine and vasopressin in a spontaneous ventricular fibrillation swine model

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