המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-13 18:05:42 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) – Canadian researchers report in the July 14th issue of The Lancet that they have found no survival advantage in using vasopressin over epinephrine for hospital patients in cardiac arrest.
Dr. Ian G. Stiell, from the Ottawa Health Research Unit, and colleagues randomized patients who experienced in-hospital cardiac arrest to vasopressin (104 subjects) or epinephrine (96 subjects). The investigators found that 1-hour survival and survival to hospital discharge did not differ between the groups.
Furthermore, among those patients who survived, median Mini-Mental State Examination scores were similar in both treatment groups, as were median cerebral performance category scores.
Given these data, the researchers write that "we cannot recommend the routine use of vasopressin for in-hospital cardiac arrest, and disagree with the American Heart Association (AHA) guidelines, which recommend vasopressin as an alternative therapy for cardiac arrest."
In an interview with Reuters Health, Dr. Stiell said that "this is an evidence-based era and the onus is on the medical profession to not adopt new therapies unless they are proven to be effective. We can blame the previous generation for adopting epinephrine without strong evidence, but I fail to see why the American Heart Association should promote new therapies that are not proven to be effective."
Dr. Vinay Nadkarni, from the Alfred I. duPonte Hospital for Children, Wilmington, Delaware, told Reuters Health that "this is an excellent study and I think that we on the Emergency Cardiovascular Care Committee of the AHA agree completely with the science of the article, but disagree with the interpretation."
"I think," he added, "that the science absolutely supports exactly what the AHA recommended. So I suspect that [Dr. Stiell's conclusion] is simply a misinterpretation of what the AHA is recommending."
Dr. Nadkarni, who is the chair of the AHA's Emergency Cardiovascular Care Committee, said that the AHA recommends the use of vasopressin for refractory ventricular fibrillation and as an indeterminate treatment for out-of-hospital cardiac arrest.
For the in-hospital population studied by Stiell et al., with the availability of excellent cardiac life support, Dr. Nadkarni said that one would not expect a single drug to make a huge difference in survival outcome. "So this study is exactly consistent with AHA recommendations."
In fact, he added, much of the data in this paper were used to develop the AHA recommendations, and Dr. Stiell, he said, was on the AHA panel.
Dr. Stiell responded by noting that the distinction between the in-hospital and out-of-hospital use of vasopressin may be buried in the text of the recommendations, but does not appear in the AHA algorithms followed by most physicians.
"A more fundamental controversy however, is yet to be seriously addressed," Dr. Peter Morley from Royal Melbourne Hospital, Victoria, Australia, notes in a journal editorial. "Epinephrine itself has never been shown to be more beneficial than placebo for cardiac resuscitation in human beings."
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