Vasopressin administration has been suggested during
cardiopulmonary resuscitation, and a previous clinical trial has suggested that
vasopressin is most effective when administered with
epinephrine. Adult subjects (n = 325) who received > or =1 dose of intravenous
epinephrine during
cardiopulmonary resuscitation for nontraumatic,
out-of-hospital cardiac arrest were randomly assigned to receive 40 IU of
vasopressin (n = 167) or placebo (n = 158) as soon as possible after the first dose of
epinephrine. The rate of return of pulses was similar between the
vasopressin and placebo groups (31% vs 30%), as was the presence of pulses at the emergency department (19% vs 23%). No subgroup appeared to be differentially affected, and no effect of
vasopressin was evident after adjustment for other clinical variables. Additional open-label
vasopressin was administered by a physician after the study
drug for 19 subjects in the placebo group and 27 subjects in the
vasopressin group. Results were similar if these subjects were excluded or were assigned to an actual
drug received. Survival duration for subjects admitted to the hospital did not differ between groups. In conclusion,
vasopressin administered with
epinephrine does not increase the rate of return of spontaneous circulation.