Original Article

International Journal of Emergency Medicine

, Volume 1, Issue 4, pp 311-316

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

A treatment protocol including vasopressin and hydroxyethyl starch solution is associated with increased rate of return of spontaneous circulation in blunt trauma patients with pulseless electrical activity

  • Štefek GrmecAffiliated withCenter for Emergency Medicine Email author 
  • , Matej StrnadAffiliated withCenter for Emergency Medicine
  • , Darko ČanderAffiliated withCenter for Emergency Medicine
  • , Štefan MallyAffiliated withCenter for Emergency Medicine



Survival after cardiopulmonary resuscitation (CPR) using standard vasopressor therapy is disappointing. Vasopressin is a potent vasopressor that could become a useful therapeutic alternative in the treatment of cardiac arrest.


The aim of this prehospital prospective cohort study was to assess the influence of treatment with vasopressin and hydroxyethyl starch solution (HHS) on outcome in resuscitated blunt trauma patients with pulseless electrical activity (PEA) cardiac arrest.


Two treatment groups of resuscitated trauma patients in cardiac arrest were compared: in the epinephrine group patients received epinephrine 1 mg IV every 3 min only; in the vasopressin group patients first received hypertonic HHS and arginine vasopressin 40 units IV only or followed by epinephrine 1 mg every 3 min until cessation of CPR. Medical trauma care was provided according to advanced trauma life support (ATLS) guidelines.


The study included 31 patients and there were no significant demographic or clinical differences between the treatment groups. Significantly more circulatory restorations [11/13 (85%) vs 3/18 (17%); P < 0.01] and better 24-h survival rates [8/13 (62%) vs 2/18 (11%); P = 0.001] were observed in the vasopressin group. Average mean arterial pressure (100.4 ± 11.4 mmHg vs 80.3 ± 12.4 mmHg) and final end-tidal partial pressure of carbon dioxide (PETCO2) at admission (4.5 ± 0.9 kPa vs 2.8 ± 0.4 kPa) were also higher in the vasopressin group.


Our results suggest that victims of severe blunt trauma with PEA should be initially treated with vasopressin in combination with HHS volume resuscitation followed by standard resuscitation therapy and other procedures when appropriate. Vasopressin might be potentially lifesaving in blunt trauma cardiac arrest compared to standard treatment with epinephrine.


Advanced life support (ALS) Cardiopulmonary resuscitation (CPR) Pulseless electrical activity (PEA) Trauma Vasopressin Hypertonic hydroxyethyl starch solution (HHS)