Is There Still a Place for Vasopressors in the Treatment of Cardiac Arrest?

  • C. Sandroni
  • F. Cavallaro
  • M. Antonelli
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)


Around 300,000 people in the United States experience an out-of-hospital cardiac arrest each year, and less than 10 % of them survive to hospital discharge [1]. Survival is only slightly better for in-hospital cardiac arrest [2]. While provision of basic measures like bystander cardiopulmonary resuscitation (CPR) or early defibrillation is consistently associated with better survival [3], the benefit of advanced life support (ALS) measures, such as ventilation with advanced airway and administration of drugs, has not been clearly demonstrated [4].


Cardiac Arrest Myocardial Blood Flow Cardiopulmonary Resuscitation Advanced Life Support Coronary Perfusion Pressure 
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  1. 1.
    McNally B, Robb R, Mehta M, et al (2011) Out-of-Hospital Cardiac Arrest Surveillance — Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005–December 31, 2010. MMWR Surveill Summ 60: 1–19PubMedGoogle Scholar
  2. 2.
    Sandroni C, Nolan J, Cavallaro F, Antonelli M (2007) In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 33: 237–245PubMedCrossRefGoogle Scholar
  3. 3.
    Sasson C, Rogers MA, Dahl J, Kellermann AL (2010). Predictors of survival from out-ofhospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 3: 63–81PubMedCrossRefGoogle Scholar
  4. 4.
    Stiell IG, Wells GA, Field B, et al (2004) Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 351: 647–656PubMedCrossRefGoogle Scholar
  5. 5.
    Deakin CD, Nolan JP, Soar J, et al (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 4._Adult advanced life support. Resuscitation 81: 1305–1352PubMedCrossRefGoogle Scholar
  6. 6.
    Kern KB, Ewy GA, Voorhees WD, Babbs CF, Tacker WA (1988) Myocardial perfusion pressure: a predictor of 24-hour survival during prolonged cardiac arrest in dogs. Resuscitation 16: 241–250PubMedCrossRefGoogle Scholar
  7. 7.
    Brown CG, Katz SE, Werman HA, Luu T, Davis EA, Hamlin RL (1987) The effect of epinephrine versus methoxamine on regional myocardial blood flow and defibrillation rates following a prolonged cardiorespiratory arrest in a swine model. Am J Emerg Med 5: 362–369PubMedCrossRefGoogle Scholar
  8. 8.
    Paradis NA, Martin GB, Rivers EP, et al (1990) Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA 263: 1106–1113PubMedCrossRefGoogle Scholar
  9. 9.
    Neumar RW, Otto CW, Link MS, et al (2010) Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122: S729–767CrossRefGoogle Scholar
  10. 10.
    Schumann HJ (1983) What role do alpha-and beta-adrenoceptors play in the regulation of the heart? Eur Heart J 4 (Suppl A): 55–60PubMedCrossRefGoogle Scholar
  11. 11.
    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: 382–389PubMedCrossRefGoogle Scholar
  12. 12.
    Brown AM, Birnbaumer L (1988) Direct G protein gating of ion channels. Am J Physiol 254: H401–410PubMedGoogle Scholar
  13. 13.
    Meissner A, Morgan JP (1995) Contractile dysfunction and abnormal Ca2+ modulation during postischemic reperfusion in rat heart. Am J Physiol 268: H100–111PubMedGoogle Scholar
  14. 14.
    Gonzalez MM, Berg RA, Nadkarni VM, et al (2008) Left ventricular systolic function and outcome after in-hospital cardiac arrest. Circulation 117: 1864–1872PubMedCrossRefGoogle Scholar
  15. 15.
    Laurent I, Monchi M, Chiche JD, et al (2002) Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 40: 2110–2116PubMedCrossRefGoogle Scholar
  16. 16.
    Tang W, Weil MH, Sun S, Noc M, Yang L, Gazmuri RJ (1995) Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation 92: 3089–3093PubMedCrossRefGoogle Scholar
  17. 17.
    Ristagno G, Tang W, Huang L, et al (2009) Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation. Crit Care Med 37: 1408–1415PubMedCrossRefGoogle Scholar
  18. 18.
    Lindner KH, Strohmenger HU, Ensinger H, Hetzel WD, Ahnefeld FW, Georgieff M (1992) Stress hormone response during and after cardiopulmonary resuscitation. Anesthesiology 77: 662–668PubMedCrossRefGoogle Scholar
  19. 19.
    Zhong JQ, Dorian P (2005) Epinephrine and vasopressin during cardiopulmonary resuscitation. Resuscitation 66: 263–269PubMedCrossRefGoogle Scholar
  20. 20.
    Krismer AC, Lindner KH, Wenzel V, et al (2001) The effects of endogenous and exogenous vasopressin during experimental cardiopulmonary resuscitation. Anesth Analg 92: 1499–1504PubMedCrossRefGoogle Scholar
  21. 21.
    Lindner KH, Prengel AW, Pfenninger EG, et al (1995) Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs. Circulation 91: 215–221PubMedCrossRefGoogle Scholar
  22. 22.
    Wenzel V, Lindner KH, Krismer AC, Miller EA, Voelckel WG, Lingnau W (1999) Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prolonged cardiopulmonary resuscitation in pigs. Circulation 99: 1379–1384PubMedCrossRefGoogle Scholar
  23. 23.
    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: 486–492PubMedCrossRefGoogle Scholar
  24. 24.
    Sirinek KR, Adcock DK, Levine BA (1989) Simultaneous infusion of nitroglycerin and nitroprusside to offset adverse effects of vasopressin during portosystemic shunting. Am J Surg 157: 33–37PubMedCrossRefGoogle Scholar
  25. 25.
    Prengel AW, Lindner KH, Keller A, Lurie KG (1996) Cardiovascular function during the postresuscitation phase after cardiac arrest in pigs: a comparison of epinephrine versus vasopressin. Crit Care Med 24: 2014–2019PubMedCrossRefGoogle Scholar
  26. 26.
    Lindner KH, Dirks B, Strohmenger HU, Prengel AW, Lindner IM, Lurie KG (1997) Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet 349: 535–537PubMedCrossRefGoogle Scholar
  27. 27.
    Stiell IG, Hebert PC, Wells GA, et al (2001) Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial. Lancet 358: 105–109PubMedCrossRefGoogle Scholar
  28. 28.
    Wenzel V, Lindner KH (2001) Vasopressin and epinephrine for cardiac arrest. Lancet 358: 2080–2081PubMedCrossRefGoogle Scholar
  29. 29.
    Wenzel V, Krismer AC, Arntz HR, Sitter H, Stadlbauer KH, Lindner KH (2004) A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 350: 105–113PubMedCrossRefGoogle Scholar
  30. 30.
    Gueugniaud PY, David JS, Chanzy E, et al (2008) Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 359: 21–30PubMedCrossRefGoogle Scholar
  31. 31.
    Mentzelopoulos SD, Zakynthinos SG, Tzoufi M, et al (2009) Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest. Arch Intern Med 169: 15–24PubMedCrossRefGoogle Scholar
  32. 32.
    Sandroni C, Cavallaro F, Ferro G, et al (2003) A survey of the in-hospital response to cardiac arrest on general wards in the hospitals of Rome. Resuscitation 56: 41–47PubMedCrossRefGoogle Scholar
  33. 33.
    Mentzelopoulos SD, Zakynthinos SG, Siempos I, Malachias S, Ulmer H, Wenzel V (2011) Vasopressin for cardiac arrest: Meta-analysis of randomized controlled trials. Resuscitation 83: 32–39PubMedCrossRefGoogle Scholar
  34. 34.
    Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L (2009) Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA 302: 2222–2229PubMedCrossRefGoogle Scholar
  35. 35.
    Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL (2011) Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation 82: 1138–1143PubMedCrossRefGoogle Scholar
  36. 36.
    Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30: 2126–2128PubMedCrossRefGoogle Scholar
  37. 37.
    Bernard SA, Gray TW, Buist MD, et al (2002) Treatment of comatose survivors of out-ofhospital cardiac arrest with induced hypothermia. N Engl J Med 346: 557–563PubMedCrossRefGoogle Scholar
  38. 38.
    The Hypothermia After Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346: 549–556CrossRefGoogle Scholar
  39. 39.
    Merchant RM, Soar J, Skrifvars MB, et al (2006) Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med 34: 1935–1940PubMedCrossRefGoogle Scholar
  40. 40.
    Binks AC, Murphy RE, Prout RE, et al (2010) Therapeutic hypothermia after cardiac arrest — implementation in UK intensive care units. Anaesthesia 65: 260–265PubMedCrossRefGoogle Scholar
  41. 41.
    Stub D, Bernard S, Duffy SJ, Kaye DM (2011) Post cardiac arrest syndrome: a review of therapeutic strategies. Circulation 123: 1428–1435PubMedCrossRefGoogle Scholar
  42. 42.
    Soar J, Packham S (2010) Cardiac arrest centres make sense. Resuscitation 81: 507–508PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • C. Sandroni
  • F. Cavallaro
  • M. Antonelli

There are no affiliations available

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