The therapeutic potential of vasopressin in cardiopulmonary resuscitation

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.