Use of vasopressor drugs during cardiopulmonary resuscitation

Abstract Epinephrine therapy during cardiopulmonary resuscitation (CPR) is associated with a variety of undesirable and potentially deleterious effects. Although several large clinical trials have been performed to study the role of epinephrine during cardiac arrest, no definite evidence of benefit has been shown. In summary, it can be said that long-term survival after CPR with epinephrine is disappointing, especially when considering out-of-hospital cardiac arrest. Vital organ blood flow during CPR and neurological recovery after CPR was significantly better in pigs treated with vasopressin compared to epinephrine. Furthermore, two clinical studies evaluating both out-of-hospital and in-hospital cardiac arrest patients found higher 24-hour survival rates in patients who were resuscitated with vasopressin compared to epinephrine. Scientists at the University in Innsbruck are currently co-ordinating a multicentre randomized clinical trial under the aegis of the European Resuscitation Council to study the effects of vasopressin versus epinephrine in out-of-hospital cardiac arrest patients. Results of the anticipated total of 1500 patients enrolled may be available in 2001, and may help to determine the role of vasopressin during CPR.