Miano Todd A, Crouch Michael A
Department of Pharmacy, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia 23298-0533, USA.
Pharmacotherapy. 2006 Jun;26(6):828-39. doi: 10.1592/phco.26.6.828.
Sudden cardiac arrest is a major public heath problem, affecting more than 450,000 individuals annually. Response time and the initiation of cardiopulmonary resuscitation (CPR) remain the most important factors determining successful revival. During resuscitation, sympathomimetics are given to enhance cerebral and coronary perfusion pressures in an attempt to achieve restoration of spontaneous circulation. Epinephrine has been the preferred vasopressor since the inception of advanced cardiac life support, although the lack of definitive evidence regarding its effectiveness has created much controversy surrounding its use, including the optimum dosage. Vasopressin is an alternative vasopressor that, when given at high doses, causes vasoconstriction by directly stimulating smooth muscle V1 receptors. The 2000 American Heart Association (AHA) guidelines commented that vasopressin is a reasonable first-line vasopressor in patients with ventricular fibrillation or pulseless ventricular tachycardia. Since release of those guidelines, additional human studies support an expanded role for vasopressin, whereas other studies cast doubt regarding its efficacy compared with epinephrine. The AHA recently released revised guidelines for CPR and emergency cardiovascular care. The consensus was that vasopressors should remain a part of pulseless sudden cardiac arrest management, with epinephrine 1 mg every 3-5 minutes being the recommended adrenergic of choice. In these revised guidelines, the role of vasopressin expanded beyond previous recommendations, despite the recommendation being downgraded to class indeterminate. The guidelines comment that one dose of vasopressin 40 U may replace the first or second dose of epinephrine in all pulseless sudden cardiac arrest scenarios, including asystole and pulseless electrical activity. A consistent theme with all vasopressors in sudden cardiac arrest is that additional studies are necessary to clearly document greater efficacy compared with no treatment. Further evaluation is warranted to better assess the role of vasopressin in asystolic sudden cardiac arrest, as well as its use with epinephrine, and to determine its optimal timing of administration and potential synergistic effects.
心脏骤停是一个重大的公共卫生问题，每年影响超过45万人。反应时间和心肺复苏（CPR）的启动仍然是决定复苏成功的最重要因素。在复苏过程中，给予拟交感神经药以提高脑和冠状动脉灌注压，试图实现自主循环恢复。自高级心脏生命支持开始以来，肾上腺素一直是首选的血管加压药，尽管缺乏关于其有效性的确切证据，围绕其使用引发了诸多争议，包括最佳剂量。血管加压素是一种替代血管加压药，大剂量使用时，通过直接刺激平滑肌V1受体引起血管收缩。2000年美国心脏协会（AHA）指南指出，血管加压素是心室颤动或无脉性室性心动过速患者合理的一线血管加压药。自这些指南发布以来，更多人体研究支持血管加压素发挥更大作用，而其他研究则对其与肾上腺素相比的疗效表示怀疑。AHA最近发布了心肺复苏和紧急心血管护理的修订指南。共识是血管加压药应仍然是无脉性心脏骤停处理方法的一部分，推荐每3 - 5分钟给予1 mg肾上腺素作为首选的肾上腺素能药物。在这些修订指南中，血管加压素的作用范围比以前的建议有所扩大，尽管该建议被降级为不确定类别。指南指出，在所有无脉性心脏骤停情况，包括心脏停搏和无脉性电活动中，一剂40 U血管加压素可替代第一或第二剂肾上腺素。在心脏骤停中使用所有血管加压药的一个一致主题是，需要更多研究来明确证明与不治疗相比具有更大疗效。有必要进行进一步评估，以更好地评估血管加压素在心脏停搏性心脏骤停中的作用，以及其与肾上腺素联合使用的情况，并确定其最佳给药时机和潜在协同效应。
