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 doubleblind 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%) epinephrinetreated 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.