Title of Trial
A Comparison of Vasopressin and Epinephrine for Out-of-Hospital Cardiopulmonary Resuscitation

Date and location of presentation Presented in part at the European Resuscitation Council Scientific Congress in Florence, Italy in October 2002, and at the Scientific Sessions of the American Heart Association in Orlando, Florida in November 2003

Date and Citation of Primary Publication(s) or References
New England Journal of Medicine 2004;350:105-113.

Purpose of the Trial
The goal of this trial is to evaluate the effect of vasopressin versus epinephrine on the outcome of cardiopulmonary resuscitation (CPR) in victims of out-of-hospital cardiac arrests.

Study Categories
Ventricular arrhythmias/Sudden Death

Patient Population
Victims of out-of-hospital cardiac arrests

Inclusion Criteria

• Adult patients presenting with out-of-hospital ventricular fibrillation (VF), pulseless electrical activity (PEA), or asystole requiring CPR.

Exclusion Criteria

• Successful defibrillation without the administration of a vasopressor
• Documented terminal illness
• Lack of intravenous access
• Hemorrhagic shock
• Cardiac arrest after trauma
• Age < 18 years
• Presence of do-not-resuscitate order

Study Design
Randomized prospective trial of vasopressin versus epinephrine

Primary Endpoint
Survival to hospital admission

Secondary Endpoints
Survival to hospital discharge

Baseline Characteristics
Number of patients: 1,186 patients
Mean age: years 66.2 ± 14.3
Gender: % female; 30.2%
Other characteristics: Left ventricular failure 12.6%

Years Follow-up: Until hospital discharge

Results
Of the 1186 patients, 589 were assigned to receive vasopressin and 597 to receive epinephrine. The two treatment groups had similar clinical profiles. There were no significant differences in the rates of hospital admission between the vasopressin group and the epinephrine group either among patients with ventricular fibrillation (46.2 percent vs. 43.0 percent, P=0.48) or among those with pulseless electrical activity (33.7 percent vs. 30.5 percent, P=0.65). Among patients with asystole, however, vasopressin use was associated with significantly higher rates of hospital admission (29.0 percent, vs. 20.3 percent in the epinephrine group; P=0.02) and hospital discharge (4.7 percent vs. 1.5 percent, P=0.04). Among 732 patients in whom spontaneous circulation was not restored with the two injections of the study drug, additional treatment with epinephrine resulted in significant improvement in the rates of survival to hospital admission and hospital discharge in the vasopressin group, but not in the epinephrine group (hospital admission rate, 25.7 percent vs. 16.4 percent; P=0.002; hospital discharge rate, 6.2 percent vs. 1.7 percent; P=0.002). Cerebral performance was similar in the two groups.

Sponsor
None

Trial Status: Completed

Review written by Samir Saba, MD