Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation

Background Studies in animals have suggested that intravenous vasopressin is associated with better vital-organ perfusion and resuscitation rates than is epinephrine in the treatment of cardiac arrest. We did a randomised comparison of vasopressin with epinephrine in patients with ventricular fibrillation in out-of-hospital cardiac arrest. Methods 40 patients in ventricular fibrillation resistant to electrical defibrillation were prospectively and randomly assigned epinephrine (1 mg intravenously; n=20) or vasopressin (40 U intravenously; n=20) as primary drug therapy for cardiac arrest, The endpoints of this double-blind study were successful resuscitation (hospital admission), survival for 24 h, survival to hospital discharge, and neurological outcome (Glasgow coma scale). Analyses were by intention to treat, Findings Seven (35%) patients in the epinephrine group and 14 (70%) in the vasopressin group survived to hospital admission (p=0.06). At 24 h, four (20%) epinephrine-treated patients and 12 (60%) vasopressin-treated patients were alive (p=0.02). Three (15%) patients in the epinephrine group and eight (40%) in the vasopressin group survived to hospital discharge (p=0.16). Neurological outcomes were similar (mean Glasgow coma score at hospital discharge 10.7 [SE 3.8] vs 11.7 [1.6], p=0.78). Interpretation In this preliminary study, a significantly larger proportion of patients treated with vasopressin than of those treated with epinephrine were resuscitated successfully from out-of-hospital ventricular fibrillation and survived for 24 h, Based upon these findings, larger multicentre studies of vasopressin in the treatment of cardiac arrest are needed.