Vasopressors in cardiopulmonary resuscitation
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OBJECTIVE: Cardiac arrest (CA) still remains a daunting emergency. Epinephrine and vasopressin are the most common used vasopressors in cardiopulmonary resuscitation (CPR). The aim of this study was to review the relevant literature regarding the efficacy of epinephrine and vasopressin in CPR. METHOD: Approaches used to access research studies included a comprehensive search of relevant electronic databases (Medline; CINAHL; EMBASE; Cochrane Review) using relevant keywords (e.g. epinephrine, vasopressin, cardiopulmonary resuscitation). Books and journals known to the authors were also used. Key journals were hand searched and references were followed up. Data were collected in June 2004 and the search was repeated in January 2005. RESULTS: Animal studies have shown that both epinephrine and vasopressin are of help in the restoration of spontaneous circulation after CA. The β1-action in myocardium has been associated with potential adverse effects. This may be the reason that many clinical trials have failed to prove any benefit on survival. Combination therapy with both drugs appears to be more effective, but has been insufficiently studied. CONCLUSIONS: None of the vasopressors researched has been proved to improve survival in humans after CA. Designing large multi-center studies with predefined endpoints is essential to elucidate the efficacy of epinephrine and vasopressin.