Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation
Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation
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DOI：
10.1056/nejmoa0706873
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发表时间：
2008-07-03
影响因子：
158.5
通讯作者：
Marret, Emmanuel
中科院分区：
文献类型：
--
作者：
Gueugniaud, Pierre-Yves;David, Jean-Stephane;Marret, Emmanuel
背景资料：在心脏骤停复苏的高级心脏生命支持管理过程中，加压素和肾上腺素的组合可能比肾上腺素或加压素单独使用更有效，但证据不足以提出临床建议。方法：在多中心研究中，我们随机分配成年人，在医院心脏骤停接受连续注射1 mg肾上腺素和40 IU血管加压素或1 mg肾上腺素和生理盐水安慰剂，如果自发循环未恢复，则随后给予相同的研究药物组合，如果需要，则随后给予额外的肾上腺素。主要终点是生存到入院;次要终点是自主循环的恢复，生存到出院，良好的神经功能恢复和1年生存率。结果：共有1442例患者被分配接受肾上腺素和血管加压素的组合，1452只接受肾上腺素。治疗组具有相似的基线特征，除了接受联合治疗组中的男性多于接受肾上腺素单药治疗组（P=0.03）。联合治疗组和单用肾上腺素组的住院生存率没有显著差异（20.7% vs. 21.3%;相对死亡风险，1.01; 95%置信区间[CI]，0.97 - 1.05），自主循环恢复（28.6% vs. 29.5%;相对危险度，1.01; 95% CI，0.97 - 1.06），生存至出院（1.7% vs. 2.3%;相对风险，1.01; 95% CI，1.00 - 1.02），1年生存率（1.3% vs. 2.1%;相对风险，1.01; 95% CI，1.00 - 1.02），或出院时神经功能恢复良好（37.5%vs.51.5%;相对危险度，1.29; 95%CI，0.81 ~ 2.06）结论：与肾上腺素单用相比，在院外心脏骤停的高级心脏生命支持期间联合应用血管加压素和肾上腺素并不能改善预后。（ClinicalTrials.gov编号，NCT 00127907.）。
Background: During the administration of advanced cardiac life support for resuscitation from cardiac arrest, a combination of vasopressin and epinephrine may be more effective than epinephrine or vasopressin alone, but evidence is insufficient to make clinical recommendations.Methods: In a multicenter study, we randomly assigned adults with out-of-hospital cardiac arrest to receive successive injections of either 1 mg of epinephrine and 40 IU of vasopressin or 1 mg of epinephrine and saline placebo, followed by administration of the same combination of study drugs if spontaneous circulation was not restored and subsequently by additional epinephrine if needed. The primary end point was survival to hospital admission; the secondary end points were return of spontaneous circulation, survival to hospital discharge, good neurologic recovery, and 1-year survival.Results: A total of 1442 patients were assigned to receive a combination of epinephrine and vasopressin, and 1452 to receive epinephrine alone. The treatment groups had similar baseline characteristics except that there were more men in the group receiving combination therapy than in the group receiving epinephrine alone (P=0.03). There were no significant differences between the combination-therapy and the epinephrine-only groups in survival to hospital admission (20.7% vs. 21.3%; relative risk of death, 1.01; 95% confidence interval [CI], 0.97 to 1.05), return of spontaneous circulation (28.6% vs. 29.5%; relative risk, 1.01; 95% CI, 0.97 to 1.06), survival to hospital discharge (1.7% vs. 2.3%; relative risk, 1.01; 95% CI, 1.00 to 1.02), 1-year survival (1.3% vs. 2.1%; relative risk, 1.01; 95% CI, 1.00 to 1.02), or good neurologic recovery at hospital discharge (37.5% vs. 51.5%; relative risk, 1.29; 95% CI, 0.81 to 2.06).Conclusions: As compared with epinephrine alone, the combination of vasopressin and epinephrine during advanced cardiac life support for out-of-hospital cardiac arrest does not improve outcome. (ClinicalTrials.gov number, NCT00127907.).