# 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.

## Key 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.