The therapeutic potential of vasopressin in cardiopulmonary resuscitation.
ABSTRACT Adrenaline has been the gold standard pressor agent used during cardiopulmonary resuscitation. Nonetheless, recent evidence suggests that there is no difference in survival rates between patients receiving adrenaline, and those receiving a placebo during resuscitation. Research and development of new pressor agents for use during cardiopulmonary resuscitation has therefore been ongoing, in search of a better pressor than adrenaline. Initial data from multiple animal studies, in addition to two small studies in humans (comparing vasopressin with a control treatment, in the management of cardiac arrest in humans and animals), showed that vasopressin was superior to both adrenaline and placebo. Consequently, a recent multicentre trial evaluated the efficacy of vasopressin versus adrenaline on survival among adults who have an out-of-hospital cardiac arrest. This study demonstrated that the effects of vasopressin were similar to those of adrenaline in the management of ventricular fibrillation and pulseless electrical activity, but vasopressin was superior to adrenaline in patients with asystole. The use of vasopressin, followed by adrenaline, was more effective than the use of adrenaline alone in patients with refractory cardiac arrest. Further studies are needed in order to establish the definitive role of vasopressin in the cardiopulmonary resuscitation guidelines.
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ABSTRACT: Objective – To discuss 3 potential mechanisms for loss of peripheral vasomotor tone during vasodilatory shock; review vasopressin physiology; review the available animal experimental and human clinical studies of vasopressin in vasodilatory shock and cardiopulmonary arrest; and make recommendations based on review of the data for the use of vasopressin in vasodilatory shock and cardiopulmonary arrest.Data Sources – Human clinical studies, veterinary experimental studies, forum proceedings, book chapters, and American Heart Association guidelines.Human and Veterinary Data Synthesis – Septic shock is the most common form of vasodilatory shock. The exogenous administration of vasopressin in animal models of fluid-resuscitated septic and hemorrhagic shock significantly increases mean arterial pressure and improves survival. The effect of vasopressin on return to spontaneous circulation, initial cardiac rhythm, and survival compared with epinephrine is mixed. Improved survival in human patients with ventricular fibrillation, pulseless ventricular tachycardia, and nonspecific cardiopulmonary arrest has been observed in 4 small studies of vasopressin versus epinephrine. Three large studies, though, did not find a significant difference between vasopressin and epinephrine in patients with cardiopulmonary arrest regardless of initial cardiac rhythm. No veterinary clinical trials have been performed using vasopressin in cardiopulmonary arrest.Conclusion – Vasopressin (0.01–0.04 U/min, IV) should be considered in small animal veterinary patients with vasodilatory shock that is unresponsive to fluid resuscitation and catecholamine (dobutamine, dopamine, and norepinephrine) administration. Vasopressin (0.2–0.8 U/kg, IV once) administration during cardiopulmonary resuscitation in small animal veterinary patients with pulseless electrical activity or ventricular asystole may be beneficial for myocardial and cerebral blood flow.03/2009; 19(2):145 - 157. DOI:10.1111/j.1476-4431.2008.00352.x
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ABSTRACT: In December 2005, the American Heart Association published new guidelines for cardiopulmonary cerebral resuscitation (CPCR) in humans for the 1st time in 5 years. Many of the recommendations are based on research conducted in animal species and may be applicable to small animal veterinary patients. One important change that may impact how CPCR is performed in veterinary medicine is the recommendation to avoid administration of excessive ventilatory rates because this maneuver severely decreases myocardial and cerebral perfusion, decreasing the chance of survival. The new guidelines also emphasize the importance of providing well-executed, continuous, uninterrupted chest compressions. Interruption of chest compressions should be avoided and, if necessary, should be minimized to <10 seconds. During defibrillation, immediate resumption of chest compressions for 2 minutes after a single shock, before reassessment of the rhythm by ECG, is recommended. This recommendation replaces previous recommendations for the delivery of 3 defibrillatory shocks in rapid succession. Allowing permissive hypothermia postresuscitation has been found to be beneficial and may increase success rate. Medications utilized in cardiopulmonary resuscitation, including amiodarone, atropine, epinephrine, lidocaine, and vasopressin, along with the indications, effects, routes of administration, and dosages, are discussed. The application of the new guidelines to veterinary medicine as well as a review of cardiopulmonary resuscitation in small animals is provided.Journal of Veterinary Internal Medicine 02/2008; 22(1):9-25. DOI:10.1111/j.1939-1676.2007.0033.x · 2.22 Impact Factor