Return of spontaneous circulation in cardiac arrest : vasopressin vs adrenaline

Abstract

Adrenaline has been incorporated in the resuscitation guidelines all over the world since the 1960’s, including Malta which follows the European Resuscitation Council (ERC) guidelines. However, recent studies have been questioning the use of adrenaline and whether a formerly used vasopressor named vasopressin may replace adrenaline during cardiopulmonary resuscitation (CPR), and if it is better at creating a return of spontaneous circulation (ROSC) in patients with cardiac arrest. In view of this controversy, the current investigation is aimed at determining whether vasopressin increases the chances of ROSC with patients in cardiac arrest when compared to adrenaline. As a result, the PICO question was set: “In adult patients during CPR (P), is adrenaline (I) compared to vasopressin (C) more effective in treating cardiac arrest (O)?” A search strategy using multiple search engines and portals, including the University of Malta’s e-library, involved an assimilation of 4 systematic reviews and meta-analysis, 4 randomized controlled trials (RCT) and two observational prospective studies. To reduce selection bias, inclusion and exclusion criteria were set as to verify that only studies which compared the outcomes and the scope of this investigation were included. The sum of 10 research studies for this investigation is evaluated using a combination of appropriate keywords. A total of 10 research studies were identified for this investigation using a combination of relevant keywords. The Critical Appraisal Skills Programme (CASP) checklist for the appraisal of RCT’s and the CASP checklists and the Centre for Evidence Based Medicine (CEBM) checklists were used for the evaluation of systematic reviews and meta-analysis and the observational prospective studies. Results derived failed to show any statistical difference between the two study drugs, however it was noted that vasopressin may be beneficial over epinephrine depending on the cardiac rhythm and whether CPR was performed in or out of hospital. The vast array of inconsistent results displays a demand for further research to question why adrenaline is still used instead of vasopressin despite the long list of side effects. Until increasingly vigorous evidence is developed, it is recommended that health professionals use the Advanced Life Support (ALS) guidelines as presented by the ERC.