Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation

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

“…Despite the sensitivity of the search strategy used and the large number of published papers on this subject (485 studies), only six trials satisfied the strict inclusion criteria. In contrast to findings regarding patients with ventricular fibrillation, pulseless electrical activity or asystole, (4,10,23,(33)(34) the results of clinical trials did not support the addition of vasopressin to epinephrine in cardiac arrest resuscitation, except in a subgroup looking at survival rate at 24h. For in-hospital patients, the vasopressin and epinephrine group failed to show any improvement compared with epinephrine for either 1 h survival or survival to hospital discharge.…”

“…Participants and the selected study design characteristics of the six cohort studies included in the metaanalysis are detailed in table 1. (7)(8)(9)(10)(11)(12) Finally, the study by Stiell et al was an in-hospital study in which time to initial drug administration was rapid (1.6min to CPR, 2.8 min to Advanced Cardiovascular Life Support (ACLS)), but the other five studies were out-of-hospital studies. The methodologies for the six studies were deemed too different to be compared and thus a meta-analysis was not attempted to combine in-hospital and out-of-hospital arrests together.…”

Vasopressors for cardiopulmonary resuscitation

“…This group went on to echo their findings in a larger (40 patient) study (Lindner et al 1997) which recruited patients in ventricular fibrillation, and showed a benefit of vasopressin over adrenaline in initially restoring circulation.…”

Is There Still a Place for Vasopressors in the Treatment of Cardiac Arrest?

“…In a fi rst small randomized trial on 40 prehospital patients who had not responded to three consecutive defi brillation shocks, the administration of 40 IU of vasopressin versus 1 mg of epinephrine was associated with a 50% increase in survival to hospital admission and to a 66% increase of survival at 24 hours [26]. However, a subsequent randomized placebo-controlled trial on 200 adult in-hospital patients comparing the same doses as in the previous study did not confi rm those results [27].…”