Abstract 176: A Randomized, Double-Blind Multicenter Trial Comparing Vasopressin and Adrenaline in Patients with Cardiac Arrest at the Emergency Department (Preadmission Intravenous Vasopressin, Adrenaline Outcome Trial [PIVOT

Abstract

Aims Recently, vasopressin has been used in cardiac arrest patients. In human studies on vasopressin, clinical trials have produced conflicting results. We aimed to compare vasopressin and adrenaline in the treatment of cardiac arrest at the Emergency Department (ED). Methods This was a randomised, double-blind, multi-centre, parallel-design clinical trial involving four hospitals. All cardiac arrest patients (confirmed by the absence of pulse, unresponsiveness and apnea) aged above 16 were eligible (age 21 and above for one hospital). The exclusion criteria were traumatic cardiac arrest or contraindicated cardio-pulmonary resuscitation (CPR). Eligible patients were randomly assigned to receive adrenaline (1 mg) or vasopressin (40 IU) in the ED. The primary outcome was survival to hospital discharge (defined as patient discharged alive or survival to 30 days post arrest). Results We recruited 727 eligible patients (adrenaline= 353; vasopressin= 374) whose baseline characteristics in both groups were comparable. After adjustment for race, medical history, bystander CPR and prior adrenaline given, more patients survived to hospital admission with vasopressin (22•2%) than adrenaline (16•7%) (p=0•047, RR=1•43, 95% CI=1•02- 2•04). No significant differences were noted for return of spontaneous circulation. Eight patients (2•3%) from the adrenaline and 11 (2•9%) from the vasopressin group survived to hospital discharge. After adjusting for race, medical history, bystander CPR and previous adrenaline given, there was no significant difference (p=0•274, RR= 1•72, 95% CI=0•65 -4•51). Post hoc analysis suggested improved outcomes for vasopressin in patients with prolonged arrest times. Conclusion Vasopressin seems to improve survival to admission in patients with prolonged cardiac arrest but not long term survival. Further studies on the effect of vasopressin on patients with prolonged arrest are needed. (ClinicalTrials.gov number, NCT00358579 )