Skip to main content
SpringerLink
Log in

Vasopressoren bei der kardiopulmonalen Reanimation

Möglichkeiten und Grenzen

Vasopressors in cardiopulmonary resuscitation

Opportunities and limits

  • Leitthema
  • Published:
Notfall + Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Arginin-Vasopressin (Vasopressin) wird heute als integraler Bestandteil der neuroendokrinen Stressantwort bei einem Herz-Kreislauf-Stillstand angesehen. Die enge Beziehung zwischen endogener Vasopressin-Sekretion und dem Überleben eines Herz-Kreislauf-Stillstands hat zu einer Anzahl von experimentellen Studien geführt, bei denen ein Überlebensvorteil mit Vasopressin im Vergleich zu Adrenalin gezeigt werden konnte. Aktuelle Ergebnisse experimenteller Studien schreiben Vasopressin und Adrenalin eine ähnliche Potenz in der Wiederherstellung eines Spontankreislaufs beim bei Herz-Kreislauf-Stillstand zu. Bisher ließen sich in der klinischen Anwendung in Bezug auf die Langzeitüberlebensraten keine signifikanten Unterschiede beweisen bzw. konnten die Vorteile, die im Rahmen von experimentellen Studien aufgezeigt wurden, nicht reproduziert werden. Die neuesten internationalen Reanimationsrichtlinien schlagen Vasopressin daher lediglich als einen alternativen Vasopressor zum Standardmedikament Adrenalin vor.

Im vorliegenden Artikel wird die aktuelle Literatur bezüglich Vasopressin diskutiert. Dabei wird vermutet, dass durch das Design der bisher durchgeführten Studien potenzielle Vorteile von Vasopressin maskiert wurden. Ein Schlüsselproblem scheinen die Ein- und Ausschlusskriterien für präklinische Reanimationsstudien darzustellen, da die Randomisierung von asystolen Patienten zu unbefriedigenden Ergebnissen geführt hat. Diese Vermutung muss allerdings im Sinne der evidenzbasierten Medizin durch weitere multizentrisch angelegte Studien mit adaptierten Ein- und Ausschlusskriterien verifiziert werden.

Abstract

Up to date, arginine-vasopressin (vasopressin) constitutes an integral part of the neuroendocrine stress response during cardiac arrest. A strong association between endogenous vasopressin secretion and outcome from cardiac arrest has led to a number of experimental studies indicating a survival benefit of vasopressin compared to epinephrine. Current data suggest that both epinephrine and vasopressin are equally effective to restore spontaneous circulation in cardiac arrest. Up to today, no significant difference regarding the long-time survival rate could be shown and the advantages of vasopressin depicted in various experimental investigations, could not been reproduced, respectively. The latest international guidelines recommend vasopressin merely as an alternative drug to the standard therapy epinephrine during cardiopulmonary resuscitation. There are several presumptions, that the potential advantages of vasopressin during the resuscitation were masked by the design of recent trials. The main problem of these pre-hospital resuscitation trials could be the in- and exclusion criteria. The randomisation of patients suffering from asystole may distort the statistical interpretation because the long-time survival rate of asystolic patients is generally poor. But this suspicion needs to be confirmed by further multicenter trials with adapted inclusion and exclusion criteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Abu-Laban RB, McIntyre CM, Christenson JM et al (2006) Aminophylline in bradyasystolic cardiac arrest: a randomised placebo-controlled trial. Lancet 367:1577–1584

    Article  PubMed  Google Scholar 

  2. Bottiger BW, Arntz HR, Chamberlain DA et al (2008) Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med 359:2651–2662

    Article  PubMed  Google Scholar 

  3. Bunch TJ, White RD, Gersh BJ et al (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348:2626–2633

    Article  PubMed  Google Scholar 

  4. Bunch TJ, White RD, Gersh BJ et al (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348(26):2626–2633

    Article  PubMed  Google Scholar 

  5. Callaway CW, Hostler D, Doshi AA et al (2002) Usefulness of vasopressin administered with epinephrine during out-of-hospital cardiac arrest. N Engl J Med 346:549–556

    Article  Google Scholar 

  6. Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK (2002) Changing incidence of out-of-hospital ventricular fibrillation, 1980–2000. J Am Med Assoc 288:3008–3013

    Article  Google Scholar 

  7. Ditchey RV, Lindenfeld J (1988) Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation 78:382–389

    CAS  PubMed  Google Scholar 

  8. Fox AW, May RE, Mitch WE (1992) Comparison of peptide and nonpeptide receptor-mediated responses in rat tail artery. J Cardiovasc Pharmacol 20(2):282–289

    Article  CAS  PubMed  Google Scholar 

  9. Gottlieb R (1896/97) Über die Wirkung der Nebennieren-Extrakte auf Herz und Blutdruck. Arch Exp Pathol Phramakol 38:99–112

    Article  Google Scholar 

  10. Gueugniaud PY, David JS, Chanzy E et al (2008) Vasopressin and epinephrine vs. Epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 359:21–30

    Article  CAS  PubMed  Google Scholar 

  11. Gueugniaud PY, Mols P, Goldstein P et al (1998) A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. N Engl J Med 339:1595–1601

    Article  CAS  PubMed  Google Scholar 

  12. Hallstrom A, Cobb L, Johnson E et al (2000) Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 342:1546–1553

    Article  CAS  PubMed  Google Scholar 

  13. Hallstrom A, Rea TD, Sayre MR et al (2006) Manual chest compression vs. use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. J Am Med Assoc 295:2620–2628

    Article  CAS  Google Scholar 

  14. Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556

    Article  Google Scholar 

  15. Li PF, Chen TT, Zhang JM (1999) Clinical study on administration of vasopressin during closed chest cardiopulmonary resuscitation. Chinese Crit Care Med 11:28–31

    Google Scholar 

  16. Lienhart HG, Wenzel V, Braun J et al (2007) Vasopressin for therapy of persistent traumatic hemorrhagic shock: the VITRIS at study. Anaesthesist 56:50, 145–148

    Article  Google Scholar 

  17. Lindner KH, Dirks B, Strohmenger HU et al (1997) Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet 349:535–537

    Article  CAS  PubMed  Google Scholar 

  18. Lindner KH, Haak T, Keller A et al (1996) Release of endogenous vasopressors during and after cardiopulmonary resuscitation. Heart 75:145–150

    Article  CAS  PubMed  Google Scholar 

  19. Lindner KH, Prengel AW, Brinkmann A et al (1996) Vasopressin administration in refractory cardiac arrest. Ann Intern Med 124:1061–1064

    CAS  PubMed  Google Scholar 

  20. Lindner KH, Prengel AW, Pfenninger EG et al (1995) Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs. Circulation 91:215–221

    CAS  PubMed  Google Scholar 

  21. Lindner KH, Strohmenger HU, Ensinger H et al (1992) Stress hormone response during and after cardiopulmonary resuscitation. Anaesthesiology 77:662–668

    Article  CAS  Google Scholar 

  22. Mally S, Jelatancev A, Grmec S (2007) Effects of epinephrine and vasopressin an end-tidal carbon dioxide tension and mean arterial blood pressure in out-of-hospital cardiopulmonary resuscitation: an observational study. Crit Care 11:R39

    Article  PubMed  Google Scholar 

  23. Mentzelopoulos SD, Zakynthinos SG, Tzoufi M et al (2009) Vasopressin, epinephrine and corticosteroids for in-hospital cardiac arrest. Arch Intern Med 169:15–24

    Article  CAS  PubMed  Google Scholar 

  24. Morris DC, Dereczyk BE, Grzybowski M et al (1997) Vasopressin can increase coronary perfusion pressure during human cardiopulmonary resuscitation. Acad Emerg Med 4:878–883

    Article  CAS  PubMed  Google Scholar 

  25. Mukoyama T, Kinoshita K, Nagao K et al (2009) Effects of vasopressin versus epinephrine in repeated administration for patients undergoing prolonged cardiopulmonary resuscitation. Resuscitation 80:755–715

    Article  CAS  PubMed  Google Scholar 

  26. Nifemann JT, Haynes KS, Garner D et al (1986) Postcountershock pulseless rhythms: response to CPR, artificial cardiac pacing, and adrenergic agonists. Ann Emerg Med 15:112–120

    Article  Google Scholar 

  27. Paradis NA, Knaut A, Halperin H (2002) Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med 347:1281–1282

    Article  PubMed  Google Scholar 

  28. Prengel AW, Lindner KH, Keller A (1996) Cerebral oxygenation during cardiopulmonary resuscitation with epinephrine and vasopressin in pigs. Stroke 27:1241–1248

    CAS  PubMed  Google Scholar 

  29. Riou B, Landais P, Vivien B et al (2001) Distribution of the probability of survival is a strategic issue for randomized trials in critically ill patients. Anesthesiology 95:56–63

    Article  CAS  PubMed  Google Scholar 

  30. Schultz CH, Rivers EP, Feldkamp CS et al (1993) A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit Care Med 21:1339–1347

    Article  CAS  PubMed  Google Scholar 

  31. Stiell IG, Hebert PC, Wells GA et al (2001) Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial. Lancet 358:105–109

    Article  CAS  PubMed  Google Scholar 

  32. Stiell IG, Walker RG, Nesbitt LP et al (2007) BIPHASIC Trial: a randomized comparison of fixed lower versus escalating higher energy levels for defibrillation in out-of-hospital cardiac arrest. Circulation 115:1511–1517

    Article  PubMed  Google Scholar 

  33. Strohmenger HU, Lindner KH, Keller A et al (1995) Concentrations of prolactin and prostaglandins during and after cardiopulmonary resuscitation. Crit Care Med 23:1347–1355

    Article  CAS  PubMed  Google Scholar 

  34. Tang W, Weil MH, Gazmuri RJ et al (1991) Pulmonary ventilation/perfusion defects induced by epinephrine during cardiopulmonary resuscitation. Circulation 84:2101–2107

    CAS  PubMed  Google Scholar 

  35. Tang W, Weil MH, Sun S et al (1995) Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation 92:3089–3093

    CAS  PubMed  Google Scholar 

  36. Wenzel V, Krismer AC, Arntz HR et al (2004) A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 350:105–113

    Article  CAS  PubMed  Google Scholar 

  37. Wenzel V, Lindner KH, Krismer AC et al (1999) Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prologed cardiopulmonary resuscitation in pigs. Circulation 99:1379–1384

    CAS  PubMed  Google Scholar 

  38. Wenzel V, Lindner KH, Prengel AW et al (1999) Vasopressin improves vital organ blood flow after prolonged cardiac arrest with postcountershock pulseless electrical activity in pigs. Crit Care Med 27:486–492

    Article  CAS  PubMed  Google Scholar 

  39. Wenzel V, Padosch SA, Lindner KH (1998) Vasopressin als alternativer Vasopressor bei der kardiopulmonalen Reanimation. Dtsch Med Wochenschr 123:877–882

    Article  CAS  PubMed  Google Scholar 

  40. Wik L, Hansen TB, Fylling F et al (2003) Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial. J Am Med Assoc 289:1389–1395

    Article  Google Scholar 

  41. Wik L, Kramer-Johansen J, Myklebust H et al (2005) Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. J Am Med Assoc 293:299–304

    Article  CAS  Google Scholar 

  42. Wolcke BB, Mauer DK, Schoefmann MF et al (2003) Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest. Circulation 108:2201–2205

    Article  PubMed  Google Scholar 

  43. Zipes DP, Wellens HJ (1998) Sudden cardiac death. Circulation 98:2334–2351

    CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich

    J. Kreutziger, P.-P. Ellmauer, K.H. Lindner &  V. Wenzel M.Sc.

Authors
  1. J. Kreutziger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P.-P. Ellmauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K.H. Lindner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Wenzel M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Wenzel M.Sc..

Additional information

Unterstützt vom Jubiläumsfonds der Österreichischen Nationalbank (Projekt 11448), Wien, Österreich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kreutziger, J., Ellmauer, PP., Lindner, K. et al. Vasopressoren bei der kardiopulmonalen Reanimation. Notfall Rettungsmed 13, 274–280 (2010). https://doi.org/10.1007/s10049-010-1283-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-010-1283-1

Schlüsselwörter

Keywords

Search

Navigation