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Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. 2008
Pierre-Yves Gueugniaud, and
Jean-Stéphane David, and
Eric Chanzy, and
Hervé Hubert, and
Pierre-Yves Dubien, and
Patrick Mauriaucourt, and
Coralie Bragança, and
Xavier Billères, and
Marie-Paule Clotteau-Lambert, and
Patrick Fuster, and
Didier Thiercelin, and
Guillaume Debaty, and
Agnès Ricard-Hibon, and
Patrick Roux, and
Catherine Espesson, and
Emgan Querellou, and
Laurent Ducros, and
Patrick Ecollan, and
Laurent Halbout, and
Dominique Savary, and
Frédéric Guillaumée, and
Régine Maupoint, and
Philippe Capelle, and
Cécile Bracq, and
Philippe Dreyfus, and
Philippe Nouguier, and
Antoine Gache, and
Claude Meurisse, and
Bertrand Boulanger, and
Claude Lae, and
Jacques Metzger, and
Valérie Raphael, and
Arielle Beruben, and
Volker Wenzel, and
Comlavi Guinhouya, and
Christian Vilhelm, and
Emmanuel Marret
Service d'Aide Médicale Urgente 69, Hospices Civils de Lyon, University of Lyon 1, Lyon, France. pierre-yves.gueugniaud@chu-lyon.fr
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.)
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