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Vasopressin or adrenaline in cardiac resuscitation
  1. Kerstin Hogg, Clinical Research Fellow,
  2. Reddy Mahu, Clinical Fellow and Ian Crawford, Research Fellow
  1. Emergency Department, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether vasopressin is more effective than adrenaline after cardiac arrest. Altogether 44 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Kerstin Hogg,Clinical Research FellowChecked by Reddy Mahu, Clinical Fellow and Ian Crawford, Research Fellow

    Clinical scenario

    A 67 year old man has been brought into the emergency department by paramedic ambulance. He was initially in ventricular fibrillation, but now has pulseless electrical activity. He collapsed 15 minutes ago and received immediate bystander basic life support. You wonder whether intravenous vasopressin would be better than adrenaline in this situation.

    Three part question

    In [cardiac resuscitation] is [vasopressin more effective than adrenaline] at achieving [return of spontaneous circulation and longterm survival]?

    Search strategy

    Medline 1966–06/03 using the OVID interface. [(exp vasopressins OR vasopressin.mp OR ADH.mp OR antidiuretic hormone.mp) AND (exp epinephrine OR epinephrine.mp OR adrenaline.mp) AND (exp resuscitation OR exp cardiopulmonary resuscitation OR exp Heart arrest OR arrest.mp OR exp ventricular fibrillation OR VF.mp OR ventricular fibrillation.mp OR asystole.mp OR EMD.mp OR electromechanical dissociation.mp OR PEA.mp OR pulseless electrical activity.mp)] LIMIT to human AND English.

    Search outcome

    Altogether 44 papers were found, only two papers compared the effects of adrenaline and vasopressin (table 4).

    Table 4

    Comment(s)

    The total number of patients studied remains small. The only RCT looking at hospital inpatients has shown no benefit in administering vasopressin during cardiac arrest.

    CLINICAL BOTTOM LINE

    Vasopressin and adrenaline are equally efficacious after cardiac arrest.

    Report by Kerstin Hogg,Clinical Research FellowChecked by Reddy Mahu, Clinical Fellow and Ian Crawford, Research Fellow

    References

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