Meta-Analysis of Efficacy of Vasopressin During Cardiopulmonary Resuscitation

Randomized controlled trials evaluating the efficacy of vasopressin versus standard of care during cardiopulmonary resuscitation (CPR) have yielded conflicting results. An electronic search of MEDLINE, Cochrane, and Embase databases was conducted through February 2022 for randomized controlled trials that evaluated the outcomes of vasopressin versus standard of care during CPR among patients with cardiac arrest. The primary outcome was the likelihood of spontaneous circulation (ROSC) return. Data were pooled using the random-effects model. The final analysis included 11 trials with 6,609 patients. The weighted mean age was 65.5 years, and 68.2% were men. There was no significant difference between the vasopressin and control groups in the likelihood of ROSC (33.1% vs 31.9%, odds ratio [OR] 1.23, 95% confidence interval [CI] 0.98 to 1.55). Subgroup analyses suggested that the use of vasopressin versus control increased the likelihood of ROSC when used in combination with steroids (p_interaction = 0.01) and in cases of in-hospital cardiac arrest (p_interaction = 0.01). There was no significant difference between the vasopressin and control groups in the likelihood of favorable neurological outcome (OR 1.14, 95% CI 0.75 to 1.71), in-hospital mortality (OR 0.89, 95% CI 0.60 to 1.31), or ventricular arrhythmias (OR 0.93, 95% CI 0.44 to 1.97). In conclusion, compared with the standard of care, the use of vasopressin during CPR did not increase the likelihood of ROSC among patients with cardiac arrest. There was no difference between the vasopressin and control groups in the likelihood of the favorable neurological outcome, in-hospital mortality, or ventricular arrhythmias.

Introduction

Cardiac arrest accounts for more than 500,000 deaths across the United States annually, with only approximately 10% of patients surviving hospital discharge.1, 2, 3 In addition to chest compressions, arrhythmia control, and airway management, current advanced cardiac life support guidelines from the American Heart Association recommend the use of intravenous adrenaline 1 mg every 3 to 5 minutes during cardiopulmonary resuscitation (CPR); this remains the standard of care globally.⁴ Vasopressin, also known as antidiuretic hormone, is a vasoactive peptide originating from the pituitary gland. Its main functions are to maintain serum osmolality, blood pressure, and body sodium content.⁵ It is also used in the management of septic shock as a second-line vasopressor.^5,6 Vasopressin helps maintain blood pressure through different receptors than those for epinephrine. It has been postulated that vasopressin may be useful as a vasoactive agent during CPR. Multiple randomized controlled trials (RCTs) have evaluated the use of vasopressin with or without steroids during CPR, yielding mixed results.6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 Hence, we conducted a meta-analysis of RCTs to investigate the efficacy of vasopressin compared with standard of care among patients with cardiac arrest.