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35 - Vasopressin and other non-adrenergic vasopressors
- from Part IV - Therapy of sudden death
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- By Anette C. Krismer, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria, Martin Dunser, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria, Karl H. Stadlbauer, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria, Karl H. Lindner, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria, Volker Wenzel, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
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- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 647-666
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- Chapter
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Summary
Basic science
The importance of arterial vascular tone in resuscitation from cardiac arrest has been described in detail in the previous chapters of this book.
Efficacy of non-adrenergic pressors
There is a longstanding concern that administration of adrenaline during resuscitation may result in detrimental effects during the postresuscitation period. Forexample, laboratory studies with adrenaline during cardiopulmonary resuscitation (CPR) showed increased myocardial oxygen consumption, ventricular arrhythmias, ventilation–perfusion defects, and postresuscitation myocardial dysfunction. Therefore, non-adrenergic vasoactive peptides such as vasopressin hold considerable promise, since theymayraise perfusion pressure without the β-receptor-mediated side effects of adrenergic vasopressors. Another intriguing possibility is that they may act synergistically when administered together with catecholamines, and that concomitant use of adrenergic drugs and nonadrenergic vasoactive peptides may allow lowering of the dose of each agent.
Vasopressin, an endogenous stress hormone
A number of fundamental endocrine responses of the human body to cardiac arrest and CPR have been investigated in past years, and are summarized in another chapter of this book. Circulating endogenous vasopressin concentrations were high in patients undergoing CPR, and levels in successfully resuscitated patients have been shown to be significantly higher than those in patients who died. This may indicate that the human body discharges vasopressin as an adjunct endogenous vasopressor to epinephrine in life-threatening situations such as cardiac arrest in order to preserve homeostasis. In a clinical study of 60 out-of-hospital cardiac arrest patients, parallel increases in plasma vasopressin and endothelin during CPR were found only in surviving patients. Thus, plasma concentrations of vasopressin may have a more important effect on CPR outcome than was previously thought. These observations prompted several investigations to assess the role of arginine vasopressin in the management of CPR in order to improve patient outcome.