Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Part I Introduction
- Part II Basic science
- Part III The pathophysiology of global ischemia and reperfusion
- Part IV Therapy of sudden death
- 23 Prevention of sudden cardiac death
- 24 Sequence of therapies during resuscitation: application of CPR
- 25 Transthoracic defibrillation
- 26 Automated external defibrillators
- 27 Public access defibrillation
- 28 The physiology of ventilation during cardiac arrest and other low blood flow states
- 29 Airway techniques and airway devices
- 30 Manual cardiopulmonary resuscitation techniques
- 31 Mechanical devices for cardiopulmonary resuscitation
- 32 Invasive reperfusion techniques
- 33 Routes of drug administration
- 34 Adrenergic agonists
- 35 Vasopressin and other non-adrenergic vasopressors
- 36 Antiarrhythmic therapy during cardiac arrest and resuscitation
- 37 Acid–base considerations and buffer therapy
- 38 Cardiac arrest resuscitation monitoring
- 39 Special considerations in the therapy of non-fibrillatory cardiac arrest
- 40 Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest
- 41 Thrombolysis during resuscitation from cardiac arrest
- 42 Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
- 43 Emergency medical services systems and out-of-hospital cardiac arrest
- 44 In-hospital resuscitation
- 45 Complications of CPR
- 46 Bringing it all together: state-of-the-art therapy for cardiac arrest
- Part V Postresuscitation disease and its care
- Part VI Special resuscitation circumstances
- Part VII Special issues in resuscitation
- Index
35 - Vasopressin and other non-adrenergic vasopressors
from Part IV - Therapy of sudden death
Published online by Cambridge University Press: 06 January 2010
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Part I Introduction
- Part II Basic science
- Part III The pathophysiology of global ischemia and reperfusion
- Part IV Therapy of sudden death
- 23 Prevention of sudden cardiac death
- 24 Sequence of therapies during resuscitation: application of CPR
- 25 Transthoracic defibrillation
- 26 Automated external defibrillators
- 27 Public access defibrillation
- 28 The physiology of ventilation during cardiac arrest and other low blood flow states
- 29 Airway techniques and airway devices
- 30 Manual cardiopulmonary resuscitation techniques
- 31 Mechanical devices for cardiopulmonary resuscitation
- 32 Invasive reperfusion techniques
- 33 Routes of drug administration
- 34 Adrenergic agonists
- 35 Vasopressin and other non-adrenergic vasopressors
- 36 Antiarrhythmic therapy during cardiac arrest and resuscitation
- 37 Acid–base considerations and buffer therapy
- 38 Cardiac arrest resuscitation monitoring
- 39 Special considerations in the therapy of non-fibrillatory cardiac arrest
- 40 Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest
- 41 Thrombolysis during resuscitation from cardiac arrest
- 42 Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
- 43 Emergency medical services systems and out-of-hospital cardiac arrest
- 44 In-hospital resuscitation
- 45 Complications of CPR
- 46 Bringing it all together: state-of-the-art therapy for cardiac arrest
- Part V Postresuscitation disease and its care
- Part VI Special resuscitation circumstances
- Part VII Special issues in resuscitation
- Index
Summary
Basic science
The importance of arterial vascular tone in resuscitation from cardiac arrest has been described in detail in the previous chapters of this book.
Efficacy of non-adrenergic pressors
There is a longstanding concern that administration of adrenaline during resuscitation may result in detrimental effects during the postresuscitation period. Forexample, laboratory studies with adrenaline during cardiopulmonary resuscitation (CPR) showed increased myocardial oxygen consumption, ventricular arrhythmias, ventilation–perfusion defects, and postresuscitation myocardial dysfunction. Therefore, non-adrenergic vasoactive peptides such as vasopressin hold considerable promise, since theymayraise perfusion pressure without the β-receptor-mediated side effects of adrenergic vasopressors. Another intriguing possibility is that they may act synergistically when administered together with catecholamines, and that concomitant use of adrenergic drugs and nonadrenergic vasoactive peptides may allow lowering of the dose of each agent.
Vasopressin, an endogenous stress hormone
A number of fundamental endocrine responses of the human body to cardiac arrest and CPR have been investigated in past years, and are summarized in another chapter of this book. Circulating endogenous vasopressin concentrations were high in patients undergoing CPR, and levels in successfully resuscitated patients have been shown to be significantly higher than those in patients who died. This may indicate that the human body discharges vasopressin as an adjunct endogenous vasopressor to epinephrine in life-threatening situations such as cardiac arrest in order to preserve homeostasis. In a clinical study of 60 out-of-hospital cardiac arrest patients, parallel increases in plasma vasopressin and endothelin during CPR were found only in surviving patients. Thus, plasma concentrations of vasopressin may have a more important effect on CPR outcome than was previously thought. These observations prompted several investigations to assess the role of arginine vasopressin in the management of CPR in order to improve patient outcome.
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- Information
- Cardiac ArrestThe Science and Practice of Resuscitation Medicine, pp. 647 - 666Publisher: Cambridge University PressPrint publication year: 2007