Štefan Mally

Effects of epinephrine and vasopressin on end-tidal carbon dioxide tension and mean arterial blood pressure in out-of-hospital cardiopulmonary resuscitation: an observational study.

IntroductionClinical data considering vasopressin as an equivalent option to epinephrine in cardiopulmonary resuscitation (CPR) are limited. The aim of this prehospital study was to assess whether the use of vasopressin during CPR contributes to higher end-tidal carbon dioxide and mean arterial blood pressure (MAP) levels and thus improves the survival rate and neurological outcome.MethodsTwo treatment groups of resuscitated patients in cardiac arrest were compared: in the epinephrine group, patients received 1 mg of epinephrine intravenously every three minutes only; in the vasopressin/epinephrine group, patients received 40 units of arginine vasopressin intravenously only or followed by 1 mg of epinephrine every three minutes during CPR. Values of end-tidal carbon dioxide and MAP were recorded, and data were collected according to the Utstein style.ResultsFive hundred and ninety-eight patients were included with no significant demographic or clinical differences between compared groups. Final end-tidal carbon dioxide values and average values of MAP in patients with restoration of pulse were significantly higher in the vasopressin/epinephrine group (p < 0.01). Initial (odds ratio [OR]: 18.65), average (OR: 2.86), and final (OR: 2.26) end-tidal carbon dioxide values as well as MAP at admission to the hospital (OR: 1.79) were associated with survival at 24 hours. Initial (OR: 1.61), average (OR: 1.47), and final (OR: 2.67) end-tidal carbon dioxide values as well as MAP (OR: 1.39) were associated with improved hospital discharge. In the vasopressin group, significantly more pulse restorations and a better rate of survival at 24 hours were observed (p < 0.05). Subgroup analysis of patients with initial asystole revealed a higher hospital discharge rate when vasopressin was used (p = 0.04). Neurological outcome in discharged patients was better in the vasopressin group (p = 0.04).ConclusionEnd-tidal carbon dioxide and MAP are strong prognostic factors for the outcome of out-of-hospital cardiac arrest. Resuscitated patients treated with vasopressin alone or followed by epinephrine have higher average and final end-tidal carbon dioxide values as well as a higher MAP on admission to the hospital than patients treated with epinephrine only. This combination vasopressor therapy improves restoration of spontaneous circulation, short-term survival, and neurological outcome. In the subgroup of patients with initial asystole, it improves the hospital discharge rate.

Vasopressin improves outcome in out-of-hospital cardiopulmonary resuscitation of ventricular fibrillation and pulseless ventricular tachycardia: a observational cohort study

IntroductionAn increasing body of evidence from laboratory and clinical studies suggests that vasopressin may represent a promising alternative vasopressor for use during cardiac arrest and resuscitation. Current guidelines for cardiopulmonary resuscitation recommend the use of adrenaline (epinephrine), with vasopressin considered only as a secondary option because of limited clinical data.MethodThe present study was conducted in a prehospital setting and included patients with ventricular fibrillation or pulseless ventricular tachycardia undergoing one of three treatments: group I patients received only adrenaline 1 mg every 3 minutes; group II patients received one intravenous dose of arginine vasopressine (40 IU) after three doses of 1 mg epinephrine; and patients in group III received vasopressin 40 IU as first-line therapy. The cause of cardiac arrest (myocardial infarction or other cause) was established for each patient in hospital.ResultsA total of 109 patients who suffered nontraumatic cardiac arrest were included in the study. The rates of restoration of spontaneous circulation and subsequent hospital admission were higher in vasopressin-treated groups (23/53 [45%] in group I, 19/31 [61%] in group II and 17/27 [63%] in group III). There were also higher 24-hour survival rates among vasopressin-treated patients (P < 0.05), and more vasopressin-treated patients were discharged from hospital (10/51 [20%] in group I, 8/31 [26%] in group II and 7/27 [26%] group III; P = 0.21). Especially in the subgroup of patients with myocardial infarction as the underlying cause of cardiac arrest, the hospital discharge rate was significantly higher in vasopressin-treated patients (P < 0.05). Among patients who were discharged from hospital, we found no significant differences in neurological status between groups.ConclusionThe greater 24-hour survival rate in vasopressin-treated patients suggests that consideration of combined vasopressin and adrenaline is warranted for the treatment of refractory ventricular fibrillation or pulseless ventricular tachycardia. This is especially the case for those patients with myocardial infarction, for whom vasopressin treatment is also associated with a higher hospital discharge rate.

Impact of additional module training on the level of basic life support knowledge of first year students at the University of Maribor

AimThe aim of this study was to investigate the impact of additional (two versus one session) basic life support (BLS) training of university students on knowledge and attitude concerning the performance of cardiopulmonary resuscitation.MethodsA total of 439 students in three separate groups were tested: those with no prior BLS training; BLS training in high school (part of the drivers education course); and BLS training in high school (in the drivers education course) and additional BLS training at the university.ResultsOur study showed the best results of BLS education in a group of university students who took an additional BLS module approximately half a year after the drivers education BLS course. In our study we observed equal levels of knowledge between the group with BLS training in high school and the group without any formal BLS education. The questionnaire revealed a disappointing level of knowledge about BLS in both groups.ConclusionAdditional basic life support training (two BLS training sessions: high school and university) improves retention of knowledge and attitudes concerning performing CPR in first year university students.

Timeliness of administration of vasopressors in CPR.

We commentary the recent study about combination of vasopressin and epinephrine versus epinephrine alone in out-of-hospital cardiopulmonray resuscitation. We analyse the results and methods of this study.We believe this study is more a demonstration of how important the time and timely application of vasopressors are, than evidence of insufficiency of combining vasopressin and epinephrine in the treatment of cardiac arrest.

Is there a place for vasopressin in cardiopulmonary resuscitation

We read with great interest the article by Meybohm et al.1 on the alternating administration of vasopressors in a pig model of cardiopulmonary resuscitation (CPR). Their report, regarding higher coronary and cerebral perfusion pressures and improved cerebral blood flow when administering both adrenaline and vasopressin, supports the results of our recent study2 on effects of adrenaline and vasopressin in out-of-hospital CPR. We reviewed the outcomes of more than 600 persons with out-of-hospital cardiac arrest, comparing those receiving adrenaline only with those receiving both vasopressin and adrenaline. During CPR, higher end-tidal carbon dioxide tension and mean arterial blood pressure values were observed among those treated with both vasopressin and adrenaline. Combination therapy resulted in better short-term survival and, most importantly, in better neurological outcome for survivors. In view of emerging evidence,1—4 we believe that the current CPR guidelines by the European Resucitation Council, in which vasopressin is not considered even as an alternative to adrenaline, should be revised. We suggest vasopressor strategy should be based on combining vasopressin and adrenaline, implementing synergistic effects of the two vasopressors and eliminating adverse effects of high doses of adrenaline.