Effect of vasopressin on postresuscitation ventricular function: unknown consequences of the recent Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

• Published in: Critical care medicine Vol. 32; no. 9 Suppl; p. S393
• Main Authors: Kern, Karl B, Heidenreich, Joseph H, Higdon, Travis A, Berg, Robert A, Hilwig, Ronald W, Sanders, Arthur B, Anavy, Nathan, Ewy, Gordon A
• Format: Journal Article
• Language: English
• Published: United States 01.09.2004
• Subjects: Animals; Cardiopulmonary Resuscitation - methods; Emergency Medical Services - methods; Epinephrine - pharmacology; Female; Heart Arrest - drug therapy; Male; Practice Guidelines as Topic; Swine; Vasoconstrictor Agents - pharmacology; Vasopressins - pharmacology; Ventricular Function, Left - drug effects
• ISSN: 0090-3493
• DOI: 10.1097/01.CCM.0000139459.39372.71

To compare the effect on postresuscitation left ventricular function of vasopressin vs. epinephrine used during cardiopulmonary resuscitation in a swine model of prolonged prehospital ventricular fibrillation. Prospective, randomized experimental study. University large animal resuscitation research laboratory. Forty-eight swine (29 +/- 1 kg). Resuscitation after 12.5 mins of untreated ventricular fibrillation, randomizing animals during cardiopulmonary resuscitation to treatment with epinephrine, vasopressin, or vasopressin followed by a vasopressin antagonist administered in the postresuscitation period. Serial measurements of left ventricular systolic and diastolic function (prearrest, postresuscitation at 30 mins and 6 hrs) and 24-hr survival. Animals receiving vasopressin had more postresuscitation left ventricular dysfunction than those receiving epinephrine (p < .05). The vasopressin antagonist produced vasodilation and improved early postresuscitation left ventricular systolic and diastolic function but did not have a lasting effect on such postresuscitation ventricular function and decreased 24-hr survival compared with the use of vasopressin alone (3/16 vs. 10/16 survivors; p < .05). Vasopressin use during cardiopulmonary resuscitation results in worse postresuscitation left ventricular function early but did not compromise 24-hr outcome. Reversal of vasopressin's effect with a specific V-1 antagonist in the postresuscitation period did not improve survival.