WEDNESDAY, July 2 (HealthDay News) -- Injecting the
artery-constricting hormone vasopressin in addition to adrenaline
did not improve survival among people who had sudden cardiac arrest
in an European trial, but American cardiologists said the finding
does not rule out use of that treatment in some cases.
The report comes from a group, primarily French, that several
years ago described promising results of combining vasopressin and
epinephrine -- the formal name of adrenaline -- as part of the
emergency treatment of cardiac arrest. The American Heart
Association responded to that report in guidelines saying that a
first shot of vasopressin might be substituted for adrenaline, the
traditional drug for cardiac arrest, in some cases.
But the latest report, on a total of nearly 3,000 people, found
that "the combination of vasopressin and epinephrine during
advanced cardiac life support for out-of-hospital cardiac arrest
does not improve outcome." The study was published in the July 3
issue of the
New England Journal of Medicine.
In each group, about one in five of those treated survived long
enough to be admitted to a hospital -- 20.7 percent of the combined
therapy group, 21.3 percent of the adrenaline-only group. The
one-year survival rate was 1.3 percent for those given the two
drugs, 2.1 percent of those given only adrenaline.
The reason for not giving up entirely on vasopressin is due to
the average response time in the French study, said Dr. Joseph P.
Ornato, chairman of emergency medicine at Virginia Commonwealth
University, and a member of the committee that drew up the heart
association guidelines.
"Paris is a city with a lot of traffic," Ornato said. "If you
look at the time of collapse to the time of treatment, the first
crew was at the scene in an average of 7.2 minutes. They didn't
start to treat until 16.3 minutes. The first steady drug injection
was not until 21 minutes."
That interval means everything, because "we lose roughly 10
percent of the odds of the resuscitation every minute," Ornato
said.
In Richmond, "90 percent of the time, we respond within eight
minutes or less," he said.
And so, Ornato said, "I am less than convinced that this
completely answers the question, because I don't know what it means
when your drugs don't start until 20 minutes after the heart has
stopped."
The trial "raises as many questions as it answers," said Dr.
Nisha Chandra-Strobos, chief of cardiology at the Bayview division
of Johns Hopkins University.
The slow response time is one major reason, she said: "A time to
injection of 21 minutes, the game is really over at that time."
The heart association guidelines which Ornato helped prepare
apply only to the medical personnel called for emergency treatment
of cardiac arrest. The heart association advises persons without
medical training to call for that help as quickly as possible by
dialing 911.
Emergency measures can be taken before medical help arrives.
Newly updated advice by the heart association says that simply
depressing the chest periodically and continually can contribute to
survival. If the cardiac arrest occurs in a public place such as an
airport, a portable defibrillator may be available. It should be
placed against the chest to deliver an electric shock that might
start the heart beating again.
More information
The symptoms of cardiac arrest and what to do about them are
described by the
American Heart Association.
