Comparison of Vasopressin to Epinephrine During Pediatric In-Hospital Cardiac Arrest: Survival and Physiologic Responsiveness

TL;DR

This study compared vasopressin and epinephrine during pediatric cardiac arrest and found no significant differences in survival or blood pressure response.

Contribution

The study provides new insights into vasopressin's physiologic effects during pediatric cardiac arrest.

Findings

No significant difference in time to return of spontaneous circulation between vasopressin and epinephrine.

A subset of vasopressin responders showed increased diastolic blood pressure.

Regression analysis showed no consistent blood pressure improvement with vasopressin.

Abstract

To compare post-epinephrine vasopressin administration versus epinephrine and time to return of spontaneous circulation (ROSC) during pediatric in-hospital cardiac arrest (IHCA), and explore vasopressin’s physiologic effects.

This single-center, retrospective cohort study (2017-2023) compared vasopressin patients who received ≥1 dose of preceding epinephrine and matched epinephrine-only patients based on age, illness category, and preceding epinephrine dosing. Time to ROSC was analyzed using Cox regression. Vasopressor response was defined as ≥5 mmHg increase in diastolic blood pressure (DBP).

41 matched pairs were analyzed. Median CPR duration was 36.5 [IQR 23, 48] minutes; median time to dose was 14.5 [10.8, 19] minutes. ROSC occurred in 10/41 (24%) vasopressin and 15/41 (36%) epinephrine patients (p=0.34) with no difference in time to ROSC (aHR 0.73 [95% CI 0.31 −1.7]). Vasopressor response occurred in 4/12 (33%) vasopressin and 1/7 (14%) epinephrine patients (p=0.60). Regression discontinuity analysis demonstrated a change in DBP of +2.3mmHg after vasopressin (95% CI: −11.4, 16.0) and −5.67mmHg after epinephrine (−15.13, 3.80).

No significant differences were found in time to ROSC or DBP increase between vasopressin and epinephrine given late during CPR. A subset of vasopressin responders suggests further research on intra-arrest DBP response to vasopressin is needed.