Two-Drug Treatment Didn't Improve Cardiac Arrest Survival Rates

By Ed Edelson
HealthDay Reporter
Thursday, July 3, 2008; 3:00 AM

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WEDNESDAY, July 2 (HealthDay News) -- Injecting the artery-constricting hormone vasopressin in addition to adrenaline did not improve survival among people who had sudden cardiac arrest in an European trial, but American cardiologists said the finding does not rule out use of that treatment in some cases.

The report comes from a group, primarily French, that several years ago described promising results of combining vasopressin and epinephrine -- the formal name of adrenaline -- as part of the emergency treatment of cardiac arrest. The American Heart Association responded to that report in guidelines saying that a first shot of vasopressin might be substituted for adrenaline, the traditional drug for cardiac arrest, in some cases.

But the latest report, on a total of nearly 3,000 people, found that "the combination of vasopressin and epinephrine during advanced cardiac life support for out-of-hospital cardiac arrest does not improve outcome." The study was published in the July 3 issue of the New England Journal of Medicine.

In each group, about one in five of those treated survived long enough to be admitted to a hospital -- 20.7 percent of the combined therapy group, 21.3 percent of the adrenaline-only group. The one-year survival rate was 1.3 percent for those given the two drugs, 2.1 percent of those given only adrenaline.

The reason for not giving up entirely on vasopressin is due to the average response time in the French study, said Dr. Joseph P. Ornato, chairman of emergency medicine at Virginia Commonwealth University, and a member of the committee that drew up the heart association guidelines.

"Paris is a city with a lot of traffic," Ornato said. "If you look at the time of collapse to the time of treatment, the first crew was at the scene in an average of 7.2 minutes. They didn't start to treat until 16.3 minutes. The first steady drug injection was not until 21 minutes."

That interval means everything, because "we lose roughly 10 percent of the odds of the resuscitation every minute," Ornato said.