Reduced effectiveness of vasopressin in repeated doses for patients undergoing prolonged cardiopulmonary resuscitation
Reduced effectiveness of vasopressin in repeated doses for patients undergoing prolonged cardiopulmonary resuscitation
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DOI：
10.1016/j.resuscitation.2009.04.005
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发表时间：
2009-07-01
期刊：
影响因子：
6.5
通讯作者：
Tanjoh, Katsuhisa
中科院分区：
文献类型：
--
作者：
Mukoyama, Takeo;Kinoshita, Kosaku;Tanjoh, Katsuhisa
引言：在长时间心肺复苏（CPR）过程中重复单独使用加压素的疗效尚未得到证实。本研究进行评估的有效性，反复给药的加压素与肾上腺素心肺骤停（CPA）患者接受延长CPR.Methods：我们进行了一项前瞻性随机对照研究，对患者经历了院外CPA。患者被随机分配接受最多4次注射，无论是4010的加压素（加压素组）或1毫克肾上腺素（肾上腺素组）后立即急诊室（ER）入院。随机化后排除入院前接受血管加压药或患有非心源性CPA的患者。结果：共入组336例患者（血管加压素组，n=137;肾上腺素组，n=118）。两组（加压素组与肾上腺素组）的自主循环恢复率（ROSC）（28.7%与26.6%）、24小时生存率（16.9%与20.3%）无差异。或存活至出院（5.6% vs. 3.8%）。在通过Fisher精确检验进行的亚组分析中，血管加压素组的ROSC发生率高于肾上腺素组，在目睹了心跳骤停的患者中（48.1% vs. 27.8%，p=0.010）或接受旁观者CPR的患者中（68.0% vs. 38.5%，p=0.033）。当ROSC的独立预测因素在亚组分析中计算，然而，加压素管理（比值比：0.87-0.28）并没有影响outcome.Conclusions：这是第一次报告的可能加压素单独复苏没有额外的肾上腺素。然而，在延长的高级心脏生命支持期间重复注射血管加压素或肾上腺素导致相当的生存率。皇冠版权所有（C）2009由爱思唯尔爱尔兰有限公司出版。保留所有权利。
Introduction: The efficacy of repeated administration of vasopressin alone during prolonged cardiopulmonary resuscitation (CPR) remains unconfirmed. This study was conducted to estimate the effectiveness of the repeated administration of vasopressin vs. epinephrine for cardiopulmonary arrest (CPA) patients receiving prolonged CPR.Methods: We conducted a prospective randomized controlled study on patients who experienced out-of-hospital CPA. The patients were randomly assigned to receive a maximum of four injections of either 4010 of vasopressin (vasopressin group) or 1 mg of epinephrine (epinephrine group) immediately after emergency room (ER) admission. Patients who received vasopressors before ER admission or suffered non-cardiogenic CPA were excluded after randomization.Results: In total, 336 patients were enrolled (vasopressin group, n=137; epinephrine group, n=118). No differences were found between these groups (vasopressin group vs. epinephrine group) in the rates of return of spontaneous circulation (ROSC) (28.7% vs. 26.6%), 24-h survival (16.9% vs. 20.3%). or survival to hospital discharge (5.6% vs. 3.8%). In a subgroup analysis by the Fisher's exact test, the rate of ROSC was higher in the vasopressin group than in the epinephrine group, among the patients whose arrests were witnessed (48.1% vs. 27.8%, p=0.010) or who received bystander CPR (68.0% vs. 38.5%, p=0.033). When the independent predictors of ROSC were calculated in the subgroup analysis, however, vasopressin administration (Odds ratio: 0.87-0.28) did not affect the outcome.Conclusions: This is the first report of a possible vasopressin-alone resuscitation without additional epinephrine. However, repeated injections of either vasopressin or epinephrine during prolonged advanced cardiac life support resulted in comparable survival. Crown Copyright (C) 2009 Published by Elsevier Ireland Ltd. All rights reserved.