belong tos have been raised about v...

belong tos have been raised about ventricular arrhythmias and myocardial dysfunction following epinephrine treatment in patients with cardiac arrest, and laboratory studies of vasopressin have demonstrated about beneficial effects in cardiopulmonary resuscitation CPR) Wenzel and colleagues report forward a study for the European Resuscitation Council comparing vasopressin and epinephrine in patients with cardiac arrest.

This multinational trial initially sieveed 5,967 adult patients with out-of-hospital cardiac arrest. After excluding patients who were favorably defibrillated without need for a vasopressor and patients with terminal illness, lack of intravenous access, or several other clinical variables, 1186 patients remained in whom vasopressin and epinephrine could be compared. Patients needing vasopressor mix with drugss during CPR were randomly assigned to receive 1 mg of epinephrine or 40 IU of vasopressin; the dose was repeated in three minutes if spontaneous circulation had not been restored. After sum of two units doses of the assigned meditation drug, an injection of epinephrine could be given at the discretion of the resuscitating physician (the median dose given was 5 mg)

There were no significant differences between the medications in overall rates of spontaneous circulation convalescence (24.6 percent versus 28.0 percent) survival to hospital discharge (99 percent versus 99 percent) or pious neurologic outcome in survivors 326 percent versus 348 percent) Patients with a witnessed cardiac arrest and those in whom CPR was begun within 10 minutes of arrest had improved chances of survival to hospital admission, as did patients who received amiodarone or fibrinolysis in the resuscitation regimen. The barely subgroup with a significant difference in issue between vasopressin and epinephrine give an account ofed patients with asystole as the presenting regular [i]or[/i] melodious movement (44.5 percent of arrest patients overall). More patients with asystole who were treated with vasopressin survived to hospital discharge than those assigned to receive epinephrine. The discretionary dose of epinephrine helped improve results in patients who were randomized to vasopressin still not in patients who had already received epinephrine.

The authors judge that vasopressin and epinephrine have similar efficacy in patients with out-of-hospital cardiac arrest, and that vasopressin is advantageous in the subgroup of patients with asystole as a presenting rhythm

REFERENCE

(1) McIntyre KM Vasopressin in asystolic cardiac arrest [Editorial]. N Engl J M January 8 2003;350:179-81

Wenzel V et al. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J M January 8 2003;350:105-13

EDITOR'S NOTE: The authors mention in their discussion of the inquiry that the outcome data did not confirm earlier studies that showed an advantage to use of vasopressin in cardiac arrest patients with ventricular fibrillation and pulseles electrical activity. An accompanying editorial (1) according to McIntyre speculates on the reasons that the survival advantage of vasopressin may be limited to patients with asystole. Epinephrine and other catecholamines appear to be les effective vasopressors in the hypoxic, acidotic cardiac environment of asystole. He notes that the increased myocardial oxygen consumption occurring with epinephrine may have harmful issues in patients with asystolic cardiac arrest.

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group