Vasopressin and endothelin during cardiopulmonary resuscitation.

Vital organ blood flow during cardiopulmonary resuscitation (CPR) and neurologic recovery after CPR were significantly better in pigs treated with vasopressin compared with epinephrine. Furthermore, two clinical studies evaluating both out-of-hospital and inhospital cardiac arrest patients found higher 24-hr survival rates in patients who were resuscitated with vasopressin compared with epinephrine. Scientists at the Leopold Franzens University in Innsbruck, Austria, are currently coordinating a multicenter, randomized clinical trial under the aegis of the European Resuscitation Council to study the effects of vasopressin vs. epinephrine in out-of-hospital cardiac arrest patients. Results of anticipated 1,500 enrolled patients may be available in 2001 and may help to determine the role of vasopressin during CPR. Another new, recently studied vasopressor for CPR is endothelin-1. To date, this vasopressor has only been studied as an intervention in animal CPR models, although plasma levels have been investigated in cardiac arrest patients. Initial reports found improved coronary perfusion pressure when combined with epinephrine. However, the CPR research group of the University of Arizona Sarver Heart Center found excessive vasoconstriction and worse survival than with epinephrine alone.