Abstract
Objectives
To review the literature addressing whether the use of vasopressors improves outcomes
in patients who suffer cardiac arrest.
Methods
Databases were searched using the terms: “(adrenaline or noradrenaline or vasopressor)
and (heart arrest or cardiac arrest) and therapy”. Inclusion criteria were human studies,
controlled trials, meta-analysis or case series. Exclusion criteria were articles
with no abstract, abstract-only citations without accompanying article, non-English
abstracts, vasopressor studies without human clinical trials, case reports, reviews,
and articles addressing traumatic arrest.
Results
1603 papers were identified of which 53 articles were included for review. The literature
addressed 5 main therapeutic questions. (1) Outcomes comparing any vasopressor to
placebo. (2) Outcomes comparing vasopressin (alone or in combination with epinephrine)
to epinephrine. (3) Outcomes comparing high dose epinephrine to standard dose epinephrine.
(4) Outcomes comparing any alternative vasopressor to epinephrine. (5) Outcomes examining
vasopressor use in pediatric cardiac arrest.
Conclusion
There are few studies that compare vasopressors to placebo in resuscitation from cardiac
arrest. Epinephrine is associated with improvement in short term survival outcomes
as compared to placebo, but no long-term survival benefit has been demonstrated. Vasopressin
is equivalent for use as an initial vasopressor when compared to epinephrine during
resuscitation from cardiac arrest. There is a short-term, but no long-term, survival
benefit when using high dose vs. standard dose epinephrine during resuscitation from
cardiac arrest. There are no alternative vasopressors that provide a long-term survival
benefit when compared to epinephrine. There is limited data on the use of vasopressors
in the pediatric population.
Keywords
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Article info
Publication history
Published online: March 19, 2012
Accepted:
February 27,
2012
Received in revised form:
February 15,
2012
Received:
November 30,
2011
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2012.02.029.
☆☆This review includes information on resuscitation questions developed through the C2010 Consensus on Science and Treatment Recommendations (CoSTR) process, managed by the International Liaison Committee on Resuscitation (http://www.americanheart.org//ILCOR). The questions were developed by ILCOR Task Forces, using strict conflict of interest guidelines. In general, each question was assigned to two experts to complete a detailed structured review of the literature, and complete a detailed worksheet. Worksheets are discussed at ILCOR meetings to reach consensus and will be published in 2010 as the CoSTR. The conclusions published in the final CoSTR consensus document may differ from the conclusions of this review because the CoSTR consensus will reflect input from other worksheet authors and discussants at the conference, and will take into consideration implementation and feasibility issues as well as new relevant research.
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
