Vasopressin combined with epinephrine during cardiac resuscitation a solution for the future 英文参考文献.docVIP

Available online /content/10/1/125 Commentary Vasopressin combined with epinephrine during cardiac resuscitation: a solution for the future? Volker Wenzel and Karl H Lindner Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria Corresponding author: Volker Wenzel, Volker.Wenzel@uibk.ac.at Published: 22 February 2006 Critical Care 2006, 10:125 (doi:10.1186/cc4846) This article is online at /content/10/1/125 ? 2006 BioMed Central Ltd See related research by Grmec and Mally in this issue [/content/10/1/R13] Abstract The exciting retrospective study of Grmec and Mally from Slovenia adds further support to the hypothesis that a combination of vasopressin and epinephrine given during CPR may be more effective than epinephrine alone [9]. While the authors acknowledge limitations of their investigation, such as a lack of randomizing and subgroup analysis of myocardial infarction patients, it is very impressive that 530 patients were studied in a very difficult setting without any funding. This investigation is in full agreement with studies showing that adding vasopressin in catecholamine-refractory shock states was beneficial during CPR [10], vasodilatory shock [11], and hemorrhagic shock [12]. Similar to balanced anaesthesia, it may be valuable to combine two drugs during CPR instead of increasing the dose of one drug. Accordingly, the Slovenian data confirm that the cumulative epinephrine dosage was significantly lower when additional vasopressin was employed. If the authors had used 2 × 40 IU vasopressin i.v. instead of only 1 × 40 IU vasopressin i.v., as in the present study, this effect would most probably have been even greater. Epinephrine given during cardiopulmonary resuscitation (CPR) may cause beta-mimetic complications in the postresuscitation phase. Vasopressin may be an alternative vasopressor drug d