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Vasopressin During Cardiopulmonary Resuscitation and Different Shock States

A Review of the Literature

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Abstract

Vasopressin administration may be a promising therapy in the management of various shock states. In laboratory models of cardiac arrest, vasopressin improved vital organ blood flow, cerebral oxygen delivery, the rate of return of spontaneous circulation, and neurological recovery compared with epinephrine (adrenaline). In a study of 1219 adult patients with cardiac arrest, the effects of vasopressin were similar to those of epinephrine in the management of ventricular fibrillation and pulseless electrical activity; however, vasopressin was superior to epinephrine in patients with asystole. Furthermore, vasopressin followed by epinephrine resulted in significantly higher rates of survival to hospital admission and hospital discharge. The current cardiopulmonary resuscitation guidelines recommend intravenous vasopressin 40IU or epinephrine 1mg in adult patients refractory to electrical countershock. Several investigations have demonstrated that vasopressin can successfully stabilize hemodynamic variables in advanced vasodilatory shock. Use of vasopressin in vasodilatory shock should be guided by strict hemodynamic indications, such as hypotension despite norepinephrine (noradrenaline) dosages >0.5βlg/kg/min. Vasopressin must never be used as the sole vasopressor agent. In our institutional routine, a fixed vasopressin dosage of 0.067 IU/min (i.e. 100 IU/50mL at 2 mL/h) is administered and mean arterial pressure is regulated by adjusting norepinephrine infusion. When norepinephrine dosages decrease to 0.2βg/kg/min, vasopressin is withdrawn in small steps according to the response in mean arterial pressure. Vasopressin also improved short-and long-term survival in various porcine models of uncontrolled hemorrhagic shock. In the clinical setting, we observed positive effects of vasopressin in some patients with life-threatening hemorrhagic shock, which had no longer responded to adrenergic catecholamines and fluid resuscitation. Clinical employment of vasopressin during hemorrhagic shock is experimental at this point in time.

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Acknowledgments

The authors do not have any conflict of interests regarding the drugs being discussed in this manuscript

This review was supported, in part, by the Austrian National Bank (grant no. 10618).

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, 6020, Austria

    Anette C. Krismer, Martin W. Dünser, Karl H. Lindner, Karl H. Stadlbauer, Viktoria D. Mayr, Hannes G. Lienhart & Volker Wenzel

  2. Department of Medicine, Division of Cardiology/Pulmonology, Benjamin Franklin Medical Center, Free University, Berlin, Germany

    Richard H. Arntz

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  1. Anette C. Krismer
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  2. Martin W. Dünser
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Correspondence to Anette C. Krismer.

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Krismer, A.C., Dünser, M.W., Lindner, K.H. et al. Vasopressin During Cardiopulmonary Resuscitation and Different Shock States. Am J Cardiovasc Drugs 6, 51–68 (2006). https://doi.org/10.2165/00129784-200606010-00005

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