For the critical outcome of survival to hospital discharge with CPC of 1 or 2, we found very-low-quality evidence (downgraded for very serious bias and serious imprecision) from 3 RCTs(Wenzel 2004, 105; Gueugniaud 2008, 21; Ong 2012, 953) (n=2402) comparing SDE with vasopressin and epinephrine combination therapy that showed no superiority with vasopressin and epinephrine combination (RR, 1.32; 95% CI, 0.88–1.98 and ARR, 0.5%; 95% CI, −0.2% to 1.3%, which translates to 5 more patients/1000 [95% CI, 2 fewer patients/1000 to 13 more/1000] surviving to hospital discharge with a CPC of 1 or 2 with vasopressin in combination with epinephrine).For the critical outcome of survival to hospital discharge, we found very-low-quality evidence (downgraded for very serious bias and serious imprecision) from 5 RCTs(Lindner 1997, 535; Wenzel 2004, 105; Gueugniaud 2008, 21; Ducros 2011, 453; Ong 2012, 953) (n=2438) comparing SDE to vasopressin and epinephrine combination therapy that did not show superiority with vasopressin and epinephrine combination therapy in survival to discharge (RR, 1.12; 95% CI, 0.84–1.49; P=0.45 and ARR, −0.17%; 95% CI, −1.3 to 1, which translates to 2 fewer patients/1000 [95% CI, 13 fewer patients/1000 to 10 more/1000] surviving to hospital discharge with vasopressin in combination with epinephrine). For the important outcome of survival to admission, we found moderate-quality evidence (downgraded for serious bias) from 5 RCTs(Lindner 1997, 535; Wenzel 2004, 105; Gueugniaud 2008, 21; Ducros 2011, 453; Ong 2012, 953) (n=2438) showing no significant differences in survival to hospital admission with vasopressin and epinephrine combination therapy (RR, 0.88; 95% CI, 0.73–1.06; P=0.17).For the important outcome of ROSC, we found moderate-quality evidence (downgraded for serious bias) from 6 RCTs(Lindner 1997, 535; Wenzel 2004, 105; Callaway 2006, 1316; Gueugniaud 2008, 21; Ducros 2011, 453; Ong 2012, 953) showing no ROSC advantage with vasopressin and epinephrine combination therapy (RR, 0.96; 95% CI, 0.89–1.04; P=0.31). |
We suggest against adding vasopressin to SDE during cardiac arrest (weak recommendation, moderate-quality evidence).
Values, Preferences, and Task Force Insights:
In making this recommendation, we preferred to avoid the additional expense and implementation issues required to add a drug (vasopressin) that has no evidence of additional benefit for patients. |
