Alternative CPR treatment strategy is more effective
Vasopressin followed by adrenaline may be a more effective treatment strategy for refractory cardiac arrest than adrenaline alone, say European researchers. Their finding, published in The New England Journal
of Medicine (2004;350:105) has led to a call for a revision of
cardiopulmonary resuscitation guidelines.
Researchers from Austria, Germany and Switzerland randomly assigned 1,186
patients who had suffered a cardiac arrest outside
hospital to receive either vasopressin or adrenaline (epinephrine), followed
by additional treatment with adrenaline if needed.
They found that among patients with asystole, spontaneous circulation
was restored more often in those treated with vasopressin. These patients
were also more likely still to be alive at admission to hospital (29.0
per cent of patients given vasopressin survived compared with 20.3 per
cent given adrenaline, P=0.02). Furthermore, survival until hospital
admission after additional therapy with adrenaline was higher among patients
who were initially treated with vasopressin than among those initially
treated with adrenaline (25.7 per cent of patients given vasopressin
then adrenaline survived compared with 16.4 per cent given adrenaline
alone, P=0.002).
In an accompanying editorial (ibid, p179), Kevin McIntyre of Harvard
Medical School, Boston says: “This is a remarkable outcome, given
that patients in this subgroup could have been deemed to be beyond hope
of resuscitation.” Medical policymakers should do whatever is necessary
to facilitate the orderly implementation of new guidelines based on this
new information, he adds. |
