First Department of Pulmonary and Critical Care Medicine, University of Athens Medical School, Evaggelismos General Hospital, 45-47 Ipsilandou Street, GR-10675 Athens, Greece.
Resuscitation. 2012 Jan;83(1):32-9. doi: 10.1016/j.resuscitation.2011.07.015. Epub 2011 Jul 23.
Prior meta-analyses-reported results of randomised controlled trials (RCTs) published between 1997 and 2004 failed to show any vasopressin-related benefit in cardiac arrest. Based on new RCT-data and a hypothesis of a potentially increased vasoconstricting efficacy of vasopressin, we sought to determine whether the cumulative, current evidence supports or refutes an overall and/or selective benefit for vasopressin regarding sustained restoration of spontaneous circulation (ROSC), long-term survival, and neurological outcome.
Two reviewers independently searched PubMed, EMBASE, and Cochrane Database for RCTs assigning adults with cardiac arrest to treatment with a vasopressin-containing regimen (vasopressin-group) vs adrenaline (epinephrine) alone (control-group) and reporting on long-term outcomes. Data from 4475 patients in 6 high-methodological quality RCTs were analyzed. Subgroup analyses were conducted according to initial cardiac rhythm and time from collapse to drug administration (T(DRUG))<20 min.
Vasopressin vs. control did not improve overall rates of sustained ROSC, long-term survival, or favourable neurological outcome. However, in asystole, vasopressin vs. control was associated with higher long-term survival {odds ratio (OR)=1.80, 95% confidence interval (CI)=1.04-3.12, P=0.04}. In asystolic patients of RCTs with average T(DRUG)<20 min, vasopressin vs. control increased the rates of sustained ROSC (data available from 2 RCTs; OR=1.70, 95% CI=1.17-2.47, P=0.005) and long-term survival (data available from 3 RCTs; OR=2.84, 95% CI=1.19-6.79, P=0.02).
Vasopressin use in the resuscitation of cardiac arrest patients is not associated with any overall benefit or harm. However, vasopressin may improve the long-term survival of asystolic patients, especially when average T(DRUG) is <20 min.
先前的荟萃分析报告了 1997 年至 2004 年期间发表的随机对照试验（RCT）的结果，这些结果表明加压素与心脏骤停无任何关联。基于新的 RCT 数据和加压素潜在增加血管收缩作用的假设，我们试图确定累积的当前证据是否支持或反驳加压素在维持自主循环（ROSC）、长期生存和神经功能结果方面的总体和/或选择性获益。
两位审查员独立检索了 PubMed、EMBASE 和 Cochrane 数据库，以查找将成人心脏骤停患者分配至接受含有加压素的方案（加压素组）与单独接受肾上腺素（epinephrine）治疗（对照组）的 RCT，并报告长期结局。分析了来自 6 项高方法学质量 RCT 的 4475 例患者的数据。根据初始心搏节律和从心脏骤停到药物给药的时间（T(DRUG)）<20 分钟进行亚组分析。
与对照组相比，加压素并未提高持续 ROSC、长期生存或有利的神经功能结局的总体发生率。然而，在心脏停搏患者中，与对照组相比，加压素与更高的长期生存率相关（优势比[OR] = 1.80，95%置信区间[CI] = 1.04-3.12，P = 0.04）。在 T(DRUG)<20 分钟的 RCT 中，平均 T(DRUG)<20 分钟的心脏停搏患者中，与对照组相比，加压素增加了持续 ROSC 的发生率（可从 2 项 RCT 获得数据；OR = 1.70，95%CI = 1.17-2.47，P = 0.005）和长期生存率（可从 3 项 RCT 获得数据；OR = 2.84，95%CI = 1.19-6.79，P = 0.02）。
在心脏骤停患者的复苏中使用加压素与任何总体获益或危害无关。然而，加压素可能会改善心脏停搏患者的长期生存率，特别是当平均 T(DRUG) <20 分钟时。
