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(Circulation. 1997;96:2453-2454.)
© 1997 American Heart Association, Inc.

Articles

Pressor With Promise

Using Vasopressin in Cardiopulmonary Arrest

Sumeet S. Chugh, MBBS; Keith G. Lurie, MD; ; Karl H. Lindner, MD

From The Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis (S.S.C., K.G.L.), and the Department of Anesthesiology, Ulm University, Germany (K.H.L.).

Correspondence to Keith G. Lurie, MD, Box 508, 420 Delaware St SE, Minneapolis, MN 55455. E-mail lurie002@maroon.tc.umn.edu

Key Words: cardiopulmonary resuscitation • vasopressin • pharmacology • survival

	Introduction

 
Despite their widespread use, current methods of cardiopulmonary resuscitation and advanced cardiac life support continue to yield poor results. In the United States, the national average for long-term survival after cardiac arrest in patients with an out-of-hospital arrest remains <5%. Surprisingly, the use of epinephrine, the mainstay of pharmacological therapy in cardiac arrest, is supported only by animal studies and anecdotal case reports. We would like to present evidence that vasopressin, alone or in combination with epinephrine, is more effective than epinephrine in the treatment of cardiopulmonary arrest. Its use during advanced cardiac life support may improve the chances of survival after cardiopulmonary arrest.

	Rationale for the Use of Pressor Agents in Cardiopulmonary Arrest

 
All forms of stress elicit an endocrine response. Cardiopulmonary arrest, the ultimate stress,¹ results in the release of endogenous epinephrine and norepinephrine in animals and humans. Systemic vascular resistance increases, with preferential redistribution of blood flow to myocardial and cerebral vessels.² The discovery of this pressor response prompted trials of catecholamines in animal models of cardiac arrest, ultimately leading to the use of epinephrine in human subjects. For more than three decades, epinephrine has been the drug of choice and the major pharmacological intervention in cardiac arrest.

	Does Epinephrine Improve Survival?

 
A recent randomized, controlled trial comparing epinephrine with placebo showed that neither high-dose nor standard-dose epinephrine altered survival in cardiac arrest compared with placebo.³ In that study, the immediate survival rate was 8.8%, but only 0.9% patients survived to hospital discharge. Other studies have demonstrated no improvement in survival when low-dose and high-dose (5 to 10 mg) epinephrine were . . . [Full Text of this Article]

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