Epinephrine use during
cardiopulmonary resuscitation (
CPR) is controversial because of its receptor-mediated adverse effects such as increased myocardial oxygen consumption, ventricular arrhythmias, ventilation-perfusion defect, postresuscitation myocardial
dysfunction, ventricular arrhythmias, and
cardiac failure. In the
CPR laboratory,
vasopressin improved vital organ blood flow, cerebral
oxygen delivery, resuscitability, and neurologic recovery more than did
epinephrine. In patients with out-of-hospital
ventricular fibrillation, a larger proportion of patients treated with
vasopressin survived 24 hours than did patients treated with
epinephrine. Currently, a large trial of
out-of-hospital cardiac arrest patients being treated with
vasopressin versus
epinephrine is ongoing in Germany, Austria, and Switzerland. The new international
CPR guidelines recommend 40 U
vasopressin intravenously, and 1 mg
epinephrine intravenously, as equally effective for the treatment of adult patients in
ventricular fibrillation; however, no recommendation for
vasopressin has been made to date for adult patients with
asystole and pulseless electrical activity, or in children, because of lack of clinical data. When
adrenergic vasopressors were unable to maintain arterial blood pressure in patients with vasodilatory
shock, continuous infusions of
vasopressin (0.04-0.10 U/min) stabilized cardiocirculatory parameters and even ensured weaning from
catecholamines.