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Background During the administration of advanced cardiac life support for resuscitation from cardiac arrest, a combination of vasopressin and epinephrine may be more effective than epinephrine or vasopressin alone, but evidence is insufficient to make clinical recommendations.
Methods In a multicenter study, we randomly assigned adults with out-of-hospital cardiac arrest to receive successive injections of either 1 mg of epinephrine and 40 IU of vasopressin or 1 mg of epinephrine and saline placebo, followed by administration of the same combination of study drugs if spontaneous circulation was not restored and subsequently by additional epinephrine if needed. The primary end point was survival to hospital admission; the secondary end points were return of spontaneous circulation, survival to hospital discharge, good neurologic recovery, and 1-year survival.
Results A total of 1442 patients were assigned to receive a combination of epinephrine and vasopressin, and 1452 to receive epinephrine alone. The treatment groups had similar baseline characteristics except that there were more men in the group receiving combination therapy than in the group receiving epinephrine alone (P=0.03). There were no significant differences between the combination-therapy and the epinephrine-only groups in survival to hospital admission (20.7% vs. 21.3%; relative risk of death, 1.01; 95% confidence interval [CI], 0.97 to 1.05), return of spontaneous circulation (28.6% vs. 29.5%; relative risk, 1.01; 95% CI, 0.97 to 1.06), survival to hospital discharge (1.7% vs. 2.3%; relative risk, 1.01; 95% CI, 1.00 to 1.02), 1-year survival (1.3% vs. 2.1%; relative risk, 1.01; 95% CI, 1.00 to 1.02), or good neurologic recovery at hospital discharge (37.5% vs. 51.5%; relative risk, 1.29; 95% CI, 0.81 to 2.06).
Conclusions As compared with epinephrine alone, the combination of vasopressin and epinephrine during advanced cardiac life support for out-of-hospital cardiac arrest does not improve outcome. (ClinicalTrials.gov number, NCT00127907
[ClinicalTrials.gov]
.)
Source Information
From Service d'Aide Médicale Urgente (SAMU) 69, Hospices Civils de Lyon, University of Lyon 1, Lyon (P.-Y.G., J.-S.D.); SAMU 93, Bobigny (E.C.); Health Engineering Institute, University of Lille, Lille (H.H., C.G., C.V.); Service Mobile d'Urgence et de Réanimation (SMUR), Edouard Herriot Hospital, Lyon (P.-Y.D.); SAMU 59, Lille (P.M.); SAMU 33, Bordeaux (C. Bragança); Bataillon des Marins Pompiers, Marseille (X.B.); SAMU 44, Nantes (M.-P.C.-L.); SMUR, Centre Hospitalier Universitaire (CHU) Lyon-Sud, Lyon (P.F.); SAMU 06, Nice (D.T.); SAMU 38, Grenoble (G.D.); SMUR, Beaujon Hospital, Beaujon (A.R.-H.); SAMU 31, Toulouse (P.R.); SAMU 42, Saint-Etienne (C.E.); SAMU 29, Brest (E.Q.); SMUR, CHU Lariboisière, Paris (L.D.); SMUR, CHU Pitié–Salpêtrière, Paris (P.E.); SAMU 14, Caen (L.H.); SAMU 74, Annecy (D.S.); SMUR, Croix-Rousse Hospital, Lyon (F.G.); SAMU 01, Bourg-en-Bresse (R.M.); SMUR, Maubeuge Hospital, Maubeuge (P.C.); SMUR, Dunkerque Hospital, Dunkerque (C. Bracq); SAMU 21, Dijon (P.D.); SAMU 13, Marseille (P.N.); SAMU 30, Nîmes (A.G.); SMUR, Valenciennes Hospital, Valenciennes (C.M.); SAMU 56, Vannes (B.B.); SMUR, Annemasse Hospital, Annemasse (C.L.); SMUR, Saint-Denis Hospital, Saint-Denis (J.M.); SMUR, Aulnay Hospital, Aulnay (V.R.); SMUR, Montfermeil Hospital, Montfermeil (A.B.); and Tenon Hospital, Paris (E.M.) — all in France; and Innsbruck Medical University, Innsbruck, Austria (V.W.).
Address reprint requests to Dr. Gueugniaud at the Department of Anesthesiology and Critical Care Medicine, Pôle Urgence, CHU Lyon-Sud, Pierre Bénite, Lyon 69495, France, or at pierre-yves.gueugniaud{at}chu-lyon.fr.
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