You are here

Article Text

Article menu
Best evidence topic reports
Vasopressin or adrenaline in cardiac resuscitation
Free
  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.

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

http://dx.doi.org/10.1136/emj.20.5.467

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Report by Kerstin Hogg,Clinical Research Fellow
    Checked 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⇓).

    View this table:
    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.

    References

    1. Lindner KH, Dirks B, Strohmenger H, et al. Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet1997;349:535–7.
      OpenUrlCrossRefPubMedWeb of Science
    2. Stiell IG, Hebert PC, Wells GA, et al. Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial. Lancet2001;358:105–9.
      OpenUrlCrossRefPubMedWeb of Science