Vasopressin

vasopressin

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:

Vasopressin (Pitressin)

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

Route: IV

1 Comment

  • Tom meiser says:

    Our protocol requires us to give one dose of vasopressin at some point during the course of cardiac arrest. As an acsl instructor I have talked with many e.r. Physicians who have used both and have gone back to the old stand-by epinephrine because they see no significant difference in outcomes.

Leave a Reply

Your email address will not be published. Required fields are marked *

background image Blogger Img

Peter Canning

JEMS Talk: Google Hangout

Recent Posts
Intranasal Medication April 26, 2015
SW_Rectangle The Jug March 26, 2015
SW_Rectangle The Ideal Medic March 24, 2015
The Butler Did It February 19, 2015
Categories
  • ems-health-safety (7)
  • ems-topics (703)
  • hazmat (1)
  • Uncategorized (420)
  • Comments
    bill
    The Ideal Medic
    very well put! aggression can be a good in moderation but over aggression can do harm. 1 year to 30 years no medic will know it all epically with our ever changing job description. thank you for your input!
    2015-04-26 11:46:50
    Ben Leighton
    Adenosine
    Hi. Im a UK Student Paramedic and I have a few questions regarding adenosine (we currently dont carry it) and I was wondering if any of you guys could e-mail me at ben-leighton@hotmail.co.uk and start some correspondance. Im aiming to set a proposal to my service in order to carry this drug and wanted some…
    2015-04-20 13:36:03
    Ihunanya udochu
    AHA 2015 Guidelines: A Preview
    Airway protection is important in a cardiac arrest patient especially endotracheal intubation unlike supraglottic airway which does not and there is risk of aspiration.A paramedic should learn how to intubate the trachea, pass an LMA and NG tube. Protecting the airway shouldn't be enough, paramedics should know how to position his hands, and also the…
    2015-04-07 15:56:27
    medicscribe
    No Chest Compressions
    You can't do CPR without chest compressions. If you don't do chest compressions it is not CPR. The patient's heart has stopped. Aside from opening their chest and doing cardiac massage, there is no way to make the heart pump without doing chest compressions. Chest compressions are by nature traumatic. Ribs are often broken by…
    2015-04-01 21:24:02
    Anonymous
    No Chest Compressions
    Actually, as a decision maker for an individual with osteoporosis I am facing this dilemma now. Guidance in our state's code suggests that I do not consent to a DNR unless there is a compelling reason - such as terminal illness. However, I am aware that manual CPR would be devastating to the body of…
    2015-04-01 20:57:01

    Now Available: Mortal Men

    Mortal Men is available as an electronic book for Kindle, Nook or any other e-reader. Here is a link to some of the places to buy it. The book sells for $3.99. Barnes and Noble Amazon Smashwords Scribd Also Available from iBooks

    Order My Books

    Support EMS Bloggers, Buy Their Books

    Google

    Order Books and Movies

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS