I rank Vasopressin 32 on the list of 33 drugs I carry.
We started carrying Vasopressin a few years back thanks to some initial research that showed it worked better than epinephrine in cardiac arrest. I remember reading about the study, and then trying to figure out who made vasopressin so I could buy stock in the company, thinking about all the vasopressin that would be bought. And while we eventually started carrying vasopressin, that research, of course, was not replicated in larger studies.
Here is the conclusion of a International Liaison Committee on Resuscitation (ILCOR) 2010 worksheet that looked into the question of of epinephrine versus vasopressin in cardiac arrest.
“In summary, the use of vasopressin alone or in combination with epinephrine as the first line vasopressors during resuscitation from cardiac arrest offers no benefit related to short- and long-term survival compared to the use of epinephrine alone.”
When we first got vasopressin, we were told that we could us it as a first-line vasopressor, then we wouldn’t need to give another vasopressor for twenty minutes. That sounded good. Hit them with one dose of vasopressin, and then you don’t have to worry about another epi for twenty minutes instead of giving epi every three to five minutes. Then when the 2005 AHA guidelines came out, we were told vasopressin could only be used in place of the first or second epi, which made it far less handy.
In most cardiac arrests, I go right with epi. I go with epi because that is how I have done it for years. I hardly ever think about vasopressin. I always have a hard time changing my routine to accomadate new drugs. But then once I have used them once, they become easier to remember. But with vasopressin, it is not just remembering I can give it. If I do remember I can give it, the next thought is why bother? Epi is quick and easy to give. We have premixed bristojets. To give vasopressin I have to get a syringe and draw up two 20 mg vials to get my 40 mg dose. Not practical when there is no documented benefit.
So, in summary, you can take vasopressin from my kit. I will not miss it.
I did not use it at all last year.
From our regional guidelines:
Class: Vasopressor, antidiuretic
Action: Potent alpha agonist in cardiac arrest, causes vasoconstriction
Indication: Cardiac arrest to replace first or second dose of epinephrine
Contraindication: History of hypersensitivity to vasopressin
Dose: One-time dose of 40 units IV push