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ACLS and Vasopressin

 

ACLS and Vasopressin

Vasopressin is a primary drug used in the pulseless arrest algorithm. In high concentrations, it raises blood pressure by inducing moderate vasoconstriction, and it has been shown to be more effective than epinephrine in asystolic cardiac arrest (Wenzel V, Krismer AC, Arntz HR, Sitter H, Stadlbauer KH, Lindner KH (January 2004). “A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation”. N. Engl. J. Med. 350 (2): 105–13. doi:10.1056/NEJMoa025431. PMID 14711909.)

One major indication for vasopressin over epinephrine is its lower risk for adverse side effects when compared with epinephrine. With epinephrine, some studies have shown a risk of increased myocardial oxygen consumption and post arrest arrhythmias because of an increase in heart rate and contractility (beta 1 effects). Vasopressin also is thought too cause cerebral vessel dilation and theoretically increase cerebral perfusion.

Trivia: Another name for vasopressin is antidiuretic hormone (ADH).

Routes

Vasopressin may be given IV/IO or by endotracheal tube.

Dosing

40 units of vasopressin IV/IO push may be given to replace the first or second dose of epinephrine, and at this time, there is insufficient evidence for recommendation of a specific dose per the endotracheal tube.
In the ACLS pulseless arrest algorithm, vasopressin may replace the first or second dose of epinephrine.

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  55 Responses to “ACLS and Vasopressin”

  1. Why can vasopressin only replace the first or second dose of epinephrine during resuscitation? I know that you only need to use it once but can it be used later on, such as after 2 doses of epinephrine? Is there evidence to explain why it can ONLY be used to replace the first or second dose?

    • Vasopressin is recommended to be given in replace of the first or second dose of epinephrine because the duration of time that it may take for vasopressin to have peak effect is considerably higher than epinephrine. The half-life of vasopressin is 10-20 minutes compared to epinephrine at 3-5 minutes. It is prudent therefore to give the vasopressin earlier in the dosing schedule.

      Kind regards,
      Jeff

  2. Is there any harm in giving EPI before or concurrent with the two rounds of defibrillation? I read your answer on why it isn’t recommended before the two defibrillations, but I’m still confused as to why it can’t be given with the shocks.
    Thank you!

    • In my experiences, I have seen epinephrine given as soon as possible if it does not delay chest compressions or defibrillation.
      However, since there is no clinical evidence that epinephrine or vasopressin improve survival to hospital discharge, it should not be emphasized in any way over chest compressions and defibrillation.

      Kind regards,
      Jeff

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