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1 at time of writing, PharmD Student, Faculty of Pharmaceutical Sciences,
University of British Columbia, Vancouver, British Columbia, Canada; now,
Clinical Postdoctoral Fellow, Division of Cardiology, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Alberta, Canada
2 Pharmacotherapeutic Specialist—Emergency Medicine, CSU Pharmaceutical
Sciences, Vancouver General Hospital, Vancouver; Clinical Associate Professor,
Faculty of Pharmaceutical Sciences, Associate Member, Division of Emergency
Medicine, Faculty of Medicine, University of British Columbia
3 Attending Physician and Research Director, Department of Emergency Medicine,
Vancouver General Hospital; Scientist, Vancouver Coastal Health Research
Institute Centre for Clinical Epidemiology & Evaluation; Scholar, Michael
Smith Foundation for Health Research; Assistant Professor, University of
British Columbia
Reprints: Dr. Zed, CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 W. 12th Ave., Vancouver, BC V5Z 1M9, Canada, fax 604/875-5267, zed{at}interchange.ubc.ca
OBJECTIVE: To review the efficacy and safety of vasopressin in cardiac arrest.
DATA SOURCES: MEDLINE, EMBASE, and PubMed were searched (all to June 2005) for full-text English-language publications describing trials in humans. Search terms were vasopressin, epinephrine, adrenaline, heart arrest, cardiac arrest, and clinical trial.
STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, controlled trials that evaluated efficacy or safety endpoints of vasopressin in the management of cardiac arrest were included. Efficacy outcomes included return of spontaneous circulation, successful resuscitation, survival to hospital admission, 24-hour survival, and survival to hospital discharge. Safety outcomes were as defined by each trial.
DATA SYNTHESIS: Three prospective trials were identified and included in this review. Vasopressin does not appear to offer any therapeutic advantage compared with epinephrine in the treatment of both in-hospital and out-of-hospital cardiac arrest, regardless of the presenting arrest rhythm. Although there is a suggestion that vasopressin may be effective in treatment of asystole, the evidence for this arises from a subgroup analysis that should be viewed as hypothesis generating. There are limited data describing the safety of vasopressin in cardiac arrest.
CONCLUSIONS: The current evidence for the use of vasopressin in cardiac arrest is indeterminate. Given the similarly equivocal evidence of efficacy for epinephrine, either drug could be considered the first-line agent in cardiac arrest. Placebo-controlled studies with appropriate statistical power are warranted to evaluate meaningful clinical outcomes, such as survival to hospital discharge. Further evaluation of the role of vasopressin in asystolic cardiac arrest and its use in combination with epinephrine is also justified.
Key Words: cardiac arrest: asystole, ventricular fibrillation, epinephrine, vasopressin
Published Online, August 23, 2005. www.theannals.com, DOI 10.1345/aph.1G187
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