Vasopressin over Epinephrine

Street Science


 
 

Keith Wesley | | Wednesday, June 27, 2007


Wyer PC, Perera P, Jin Z, et al: Vasopressin or Epinephrine for Out-of-Hospital Cardiac Arrest.Annals of Emergency Medicine. 48(1):86 97, 2006.

The Science

The authors of this study attempted to review the world s literature comparing vasopressin and epinephrine for out-of-hospital cardiac arrest. They limited their scope to studies that measured survival to discharge and neurologic outcome. Using a very exhaustive search and stringent criteria, they reviewed in great detail three high-quality randomized trials and one meta-analysis (a comparison of many studies). They determined that there was no evidence to support the benefit of vasopressin over epinephrine.

The Street

As a system medical director, I know full well the pressure to make changes to current drug regimens to be compliant with a perceived standard of care. It s especially true for cardiac arrest treatment because of the publicity associated with the 2005 AHA guidelines. However, the guidelines state that vasopressin may be substituted for epinephrine not must be. There are practical advantages to giving a single dose of 40 units of vasopressin for V-tach/fib and asystole, and I m all for practicality in the controlled chaos of the cardiac arrest scene. Also, animal data indicates increased coronary artery and cerebral perfusion pressures with the use of vasopressin over epinephrine. But the drug is more expensive, and controversy surrounds the issue of what to do if the patient is unresponsive to vasopressin.

This paper might provide your medical director with the necessary science to help them decide whether to add vasopressin, but it s important to recognize its limitations. The authors only examined research that measured the rate of survival to hospital discharge. As we have seen in many recent studies regarding advances in cardiac arrest care, this is not necessarily the best outcome on which to base prehospital care.

In EMS, a successful resuscitation is one in which the patient arrives at the hospital with a pulse or attains one soon afterward and is admitted. However, many other factors affect whether a patient survives to discharge, including the decision to remove them from life support or the development of medical complications, such as renal failure or sepsis.

Although studies like this one are helpful in defining the current state of the science, they do little to provide the practical knowledge necessary to make changes to EMS practice that measures success in different terms. Further complicating the understanding of the significance of such studies is that they are based on cardiac arrest care using the old 2000 AHA guidelines. Who knows what, if any, differences we may detect between the vasopressin and epinephrine when used with the new pump hard, pump fast protocols.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Cardiac and Circulation, Research

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS

 

 

 

 

 

 

 

 

 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

The Evolution of Civilian High Threat Medical Guidelines

How mass killing events have proven a need for new guidelines.
More >

Multimedia Thumb

British Medics Bid Farewell to Afghanistan Base

Medical team and troops leave Camp Bastion.
Watch It >


Multimedia Thumb

Plane Crash at Wichita Airport

Small plane crashes into airport safety building.
Watch It >


Multimedia Thumb

Authorities Investigate Firefighters at Arizona EMS Call

Confrontation caught on video involving Glendale firefighters.
Watch It >


Multimedia Thumb

Radio Problems for New York Medics

Medic’s radio failed during a call with an armed patient.
Watch It >


Multimedia Thumb

Ottawa Shooting Incident

Solider is shot by gunman at national memorial in Ottawa.
More >


Multimedia Thumb

Life Link III Trauma Tactics Conference in Minnesota

Conference was designed to enhance the skills of providers of all levels, covering rescue and prehospital situations, to transport and in-hospital treatment.
More >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >


Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >


More Product Videos >