Vasopressin or adrenaline in cardiac resuscitation

Kerstin Hogg; Reddy Mahu

doi:10.1136/emj.20.5.467

Responses

Best evidence topic reports

Vasopressin or adrenaline in cardiac resuscitation

Compose a Response to This Article

Compose Response

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

PLEASE NOTE:

A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.

I agree to and have read the terms and conditions for rapid responses and BMJ Privacy Notice *

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

Vasopressin - the continuing evidence.
Kerstin E Hogg
Published on: 18 October 2023
Re: Vasopressin or adrenaline in cardiac resuscitation
Andrew P Webster
Published on: 18 October 2023
Vasopressin and adrenaline in cardiac resuscitation - the BET.
Kerstin Hogg
Published on: 18 October 2023
Vasopressin or adrenaline in cardiac resuscitation
Thomas E Locker
Published on: 18 October 2023

Published on: 18 October 2023
Vasopressin - the continuing evidence.
- Kerstin E Hogg, Clinical Research Fellow
Dear Editor
On the 8th of this month, the large mutlicentre European Resuscitation Council study comparing the effects of adrenaline and vasopressin in out-of-hospital cardiac arrest was published. This was a mutlicentre study conducted between 1999 and 2002 in Austria, Germany and Switzerland. Patients with an out-of-hospital cardiac arrest requiring cardiopulmonary resuscitation and intravenous vasopressor the...
Show More

Dear Editor
On the 8th of this month, the large mutlicentre European Resuscitation Council study comparing the effects of adrenaline and vasopressin in out-of-hospital cardiac arrest was published. This was a mutlicentre study conducted between 1999 and 2002 in Austria, Germany and Switzerland. Patients with an out-of-hospital cardiac arrest requiring cardiopulmonary resuscitation and intravenous vasopressor therapy were included. The study shows no statistically significant benefit in primary (overall survival to hospital) or secondary (overall survival to discharge) end points. A subset analysis demonstrated that more patients in asystolic arrest survived to hospital after the administration of vasopressin as compared to adrenaline. Notably, the survival to discharge did not reach clinical significance. The sub-analysis further demonstrated that of those who did not respond to two doses of research drug and went on to be administered adrenaline, significantly more patients in the vasopressin group reached both end points.
This is the largest study addressing the question whether vasopressin should be employed in an arrest. As normal practice, the Best BET comparing these two entities has been updated to include this evidence.
Show Less

Conflict of Interest:
None declared.
- Back to top
Published on: 18 October 2023
Re: Vasopressin or adrenaline in cardiac resuscitation
- Andrew P Webster, SPR in Accident & Emergency Medicine
Dear Editor
I agree with Dr Lockers concerns regarding the publication of BETS in a peer reviewed journal. BETS are useful for introducing people to the theory of literature searching, and appraisal of published evidence, ideal skills for SPR's working towards their clinical topic review. However this does not necessarily warrant their publication in a peer reviewed journal. They occupy valuable space within a journal...
Show More

Dear Editor
I agree with Dr Lockers concerns regarding the publication of BETS in a peer reviewed journal. BETS are useful for introducing people to the theory of literature searching, and appraisal of published evidence, ideal skills for SPR's working towards their clinical topic review. However this does not necessarily warrant their publication in a peer reviewed journal. They occupy valuable space within a journal which is only published bimonthly, which could instead be used by studies with more rigourous methodology. If the EMJ is to become to be a leading worldwide journal in the field of Emergency medicine, should it be including BETS within its pages? I don't see the Lancet or the BMJ publishing 6-7 pages of medline searches each edition. Though Dr Hogg does explain that she has carried out a rigorous search, and had this checked, this itself does deviate from the initial aims of BETS as something a clinician could do in a short period of time. With the advent of nearly universal internet use is the Best bets website not the best place for them to reside?
Show Less

Conflict of Interest:
None declared.
- Back to top
Published on: 18 October 2023
Vasopressin and adrenaline in cardiac resuscitation - the BET.
- Kerstin Hogg, Clinical Research Fellow
- Other Contributors:
  Reddy Mahu, Ian Crawford
Dear Editor
We read with interest the comments on our best evidence topic review on Vasopressin or adrenaline in cardiac resuscitation and are happy to explain the process involved in producing the BET.
This literature search was first conducted in March 2002. Our initial and specific question was:
Is vasopressin more effective than adrenaline in achieving return of circulation and longte...
Show More

Dear Editor
We read with interest the comments on our best evidence topic review on Vasopressin or adrenaline in cardiac resuscitation and are happy to explain the process involved in producing the BET.
This literature search was first conducted in March 2002. Our initial and specific question was:
Is vasopressin more effective than adrenaline in achieving return of circulation and longterm survival, in human cardiac arrest?
A full and sensitive search strategy was compiled. The search strategy was checked by two additional independent doctors who cross checked their own strategies in order to maximse the sensitivity. All titles and abstracts were appraised initially by the two authors and prior to publication by the third independent author. The relevant original studies and review articles were sourced in full text (18 in total). All review articles were cross referenced.
These 18 papers were reduced to four potentially relevant papers. This included the two published studies. The search strategy and all four papers were reviewed by the Manchester Royal Infirmary Emergency Medicine journal club. A consensus decision was taken to exclude from the analysis one study reporting the effects of intravenous vasopressin on coronary perfusion pressures in 10 patients[1] and a second which reported the effects of intravenous vasopressin administered in refactory cardiac arrest, in 8 patients.[2] The first study did not use return of ciculation as an outcome, and the second did not compare the effects of vasopressin and adrenaline. The decision to publish this review was taken four months prior to publication. At that point it was reviewed by Professor Mackway-Jones, the first author repeated the search and a third independent author checked the relevant articles and search strategy.
To directly respond to your points
1. The BET addresses a specific question. We did not aim to present a vague representation of all literature on vasopressin but asked the question - is vasopressin better than adrenaline in a human cardiac arrest.
2. Dr Locker wonders why we did not include two recent reviews addressing this question. A less superficial appraisal of these papers would have revealed they found the same 4 studies. We have cross referenced all the review articles published on this subject and can find no further studies.
3. We do not pretend that these reviews are systematic reviews, (we used Medline only and do not search for unpublished data), but we do openly lay out our methodology. It would be possible for another doctor, anywhere in the world, to repeat this search exactly if they so required.
4. At present, a meta-analysis would appear wholly inappropriate to answer this question. There are only two small studies, the results of which are clearly laid out in the table. The reader is capable of drawing their own conclusions from this table. When more relevant data is available (there are at least two ongoing studies), a meta-analysis may be of use.
In conclusion, this BET is an accurate and reproducible formal review. It addresses the question posed by the authors and clearly summarises the relevant published literature.
References
(1) Morris DC. Dereczyk BE. Grzybowski M. Martin GB. Rivers EP. Wortsman J. Amico JA. Vasopressin can increase coronary perfusion pressure during human cardiopulmonary resuscitation Academic Emergency Medicine. 4(9):878-83, 1997 Sep.
(2) Lindner KH. Prengel AW. Brinkmann A. Strohmenger HU. Lindner IM. Lurie KG. Vasopressin administration in refractory cardiac arrest. Annals of Internal Medicine. 124(12):1061-4, 1996 Jun 15.
Show Less

Conflict of Interest:
None declared.
- Back to top
Published on: 18 October 2023
Vasopressin or adrenaline in cardiac resuscitation
- Thomas E Locker, Specialist Registrar
Dear Editor
The best evidence topic report (BET) by Hogg and Mahu [1] raises a number of concerns, both with the article itself and the BETs process as a whole. The relative efficacy of adrenaline and vasopressin in the management of cardiac arrest is an important subject of relevance to all who work in Emergency Medicine. For this BET to only include those papers directly comparing vasopressin and adrenaline is to...
Show More

Dear Editor
The best evidence topic report (BET) by Hogg and Mahu [1] raises a number of concerns, both with the article itself and the BETs process as a whole. The relative efficacy of adrenaline and vasopressin in the management of cardiac arrest is an important subject of relevance to all who work in Emergency Medicine. For this BET to only include those papers directly comparing vasopressin and adrenaline is to dismiss a large amount of research published in this area. A very brief search on Medline reveals a large number of articles looking at this subject, including two recently published reviews comparing adrenaline and vasopressin,[2,3] not mentioned by the authors. Surely a topic such as this should be subject to a formal literature review and meta-analysis, not the “shortcut review” method advocated by the BETs methodology.
One of the stated aims of the BET methodology is to summarize the highest level of evidence available.[4] In response to previous criticisms Professor Mackway-Jones was keen to emphasise that those undertaking BETs “go to great lengths to ensure that the search strategies used are highly sensitive” [5] It would appear from this article that this has not been the case on either count.
Given the above concerns could the Journal Editors confirm whether the BETS are subject to the same peer review process as other articles in this journal.
References
(1) Hogg K,Mahu R.Vasopressin or adrenaline in cardiac resuscitation. Emerg Med J 2003;20:467.
(2) Ong ME, Lim SH, Anantharaman V. Intravenous adrenaline or vasopressin in sudden cardiac arrest: a literature review. Ann Acad Med Singapore 2002 Nov;31(6):785-92.
(3) Nolan JP, De Latorre FJ, Steen PA, Chamberlain DA, Bossaert LL. Advanced life support drugs: do they really work? Curr Opin Crit Care 2002 Jun;8(3):212-8.
(4) Mackway-Jones K. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Emerg Med J 2003;20:464.
(5) K Mackway-Jones replies. J Accid Emerg Med 1999 16:389.
Show Less

Conflict of Interest:
None declared.
- Back to top

Main menu

Plain text

PLEASE NOTE:

Vertical Tabs

Other responses

Jump to comment:

Log in using your username and password

Main menu

Log in using your username and password

You are here

Plain text

PLEASE NOTE:

Vertical Tabs

Other responses

Jump to comment:

Read the full text or download the PDF:

Log in using your username and password