VASOPRESSIN
VERSUS EPINEPHRINE FOR INHOSPITAL CARDIAC ARREST: A RANDOMISED CONTROLLED
TRIAL.
Stiell
IG, et al. Lancet 2001 Jul 14;358(9276):105-9
BACKGROUND:
Survival rates for cardiac arrest patients, both in and out of hospital, are
poor. Results of a previous study suggest better outcomes for patients treated
with vasopressin than for those given epinephrine, in the out-of-hospital
setting. Our aim was to compare the effectiveness and safety of these drugs for
the treatment of in-patient cardiac arrest.
METHODS:
We did a triple-blind randomised trial in the emergency departments, critical
care units, and wards of three Canadian teaching hospitals. We assigned adults
who had cardiac arrest and required drug therapy to receive one dose of
vasopressin 40 U or epinephrine 1 mg intravenously, as the initial vasopressor.
Patients who failed to respond to the study intervention were given epinephrine
as a rescue medication. The primary outcomes were survival to hospital
discharge, survival to 1 h, and neurological function. Preplanned subgroup
assessments included patients with myocardial ischaemia or infarction, initial
cardiac rhythm, and age.
FINDINGS:
We assigned 104 patients to vasopressin and 96 to epinephrine. For patients
receiving vasopressin or epinephrine survival did not differ for hospital
discharge (12 [12%] vs 13 [14%], respectively; p50.67; 95% CI for absolute
increase in survival 211.8% to 7.8%) or for 1 h survival (40 [39%] vs 34 [35%];
p50.66; 210.9% to 17.0%); survivors had closely similar median mini-mental
state examination scores (36 [range 19-38] vs 35 [20-40]; p50.75) and median
cerebral performance category scores (1 vs 1).
INTERPRETATION:
We failed to detect any survival advantage for vasopressin over epinephrine. We
cannot recommend the routine use of vasopressin for inhospital cardiac arrest
patients, and disagree with American Heart Association guidelines, which
recommend vasopressin as alternative therapy for cardiac arrest.