‎ Vasopressin in Shock States and Cardiac Resuscitation

• AHA released revised guidelines for CPR and emergency cardiovascular care. The consensus was that, vasopressors should remain a part of pulseless sudden cardiac arrest management, with epinephrine 1 mg every 3-5 minutes being the recommended adrenergic of choice. In the revised guidelines, the role of vasopressin expanded beyond previous recommendations, despite the recommendation being downgraded to class indeterminate.• The guidelines comment that one dose of vasopressin (40 units I.V) may replace the first or second dose of epinephrine in all pulseless sudden cardiac arrest.• Clinical reports and experimental studies certainly support the beneficial effects of low-dose vasopressin infusions in vasodilatory shock. Nevertheless, no clinical study has yet demonstrated reduced mortality in patients treated with vasopressin.• ”Renal dose” dopamine: Dopamine selectively increases renal blood flow when administered to normal volunteers at 1-3ug/kg/minute. However, a beneficial effect of low or ”renal dose” dopamine is less proven in human patients with sepsis or other critical illness.• Epinephrine is not routinely used as an initial, single agent in septic shock because it has been shown to impair splanchnic blood flow and tissue perfusion. Although the addition of dobutamine might blunt these effects, epinephrine remains a third-line agent.• Current guidelines on the management of septic shock suggest that vasopressin use may be considered in patients with refractory septic shock despite adequate fluid resuscitation and high-dose conventional vasopressors.• Profound hypovolemic shock that is unresponsive to volume replacement or catecholamine intervention implicates a poor prognosis.• There has been growing evidence suggesting that vasopressin may be helpful in these clinical scenarios, mainly due to its extremely vasoconstrictive effect.