Epinephrine versus Vasopressin in Adult Cardiac Arrest: Role of Agonal Respirations and Patient Age

Abstract

A review of the literature regarding the use of vasopressin versus epinephrine in the treatment of out-of-hospital cardiac arrest recommends initially administering 1 mg of epinephrine, followed by alternating doses of vasopressin 40 IU and epinephrine 1 mg every 3 minutes in adults, regardless of the initial electrocardiographic rhythm. The American Heart Association—Emergency Cardiac Care Committee (AHA—ECCC) adopted this position in its recent recommendations. However, further research is required to determine whether epinephrine should always be the initial agent regardless of the initial cardiac rhythm or whether other factors need to be considered. A review of evidence that may have been overlooked by the AHA-ECCC argues for the need to consider the presence of spontaneous agonal (“gasping”) respirations and patient age before determining which vasopressor to use first.