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Erschienen in: Notfall +  Rettungsmedizin 4/2010

01.06.2010 | Leitthema

Vasopressoren bei der kardiopulmonalen Reanimation

Möglichkeiten und Grenzen

verfasst von: J. Kreutziger, P.-P. Ellmauer, K.H. Lindner, M.Sc. Prof. Dr. V. Wenzel

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 4/2010

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Zusammenfassung

Arginin-Vasopressin (Vasopressin) wird heute als integraler Bestandteil der neuroendokrinen Stressantwort bei einem Herz-Kreislauf-Stillstand angesehen. Die enge Beziehung zwischen endogener Vasopressin-Sekretion und dem Überleben eines Herz-Kreislauf-Stillstands hat zu einer Anzahl von experimentellen Studien geführt, bei denen ein Überlebensvorteil mit Vasopressin im Vergleich zu Adrenalin gezeigt werden konnte. Aktuelle Ergebnisse experimenteller Studien schreiben Vasopressin und Adrenalin eine ähnliche Potenz in der Wiederherstellung eines Spontankreislaufs beim bei Herz-Kreislauf-Stillstand zu. Bisher ließen sich in der klinischen Anwendung in Bezug auf die Langzeitüberlebensraten keine signifikanten Unterschiede beweisen bzw. konnten die Vorteile, die im Rahmen von experimentellen Studien aufgezeigt wurden, nicht reproduziert werden. Die neuesten internationalen Reanimationsrichtlinien schlagen Vasopressin daher lediglich als einen alternativen Vasopressor zum Standardmedikament Adrenalin vor.
Im vorliegenden Artikel wird die aktuelle Literatur bezüglich Vasopressin diskutiert. Dabei wird vermutet, dass durch das Design der bisher durchgeführten Studien potenzielle Vorteile von Vasopressin maskiert wurden. Ein Schlüsselproblem scheinen die Ein- und Ausschlusskriterien für präklinische Reanimationsstudien darzustellen, da die Randomisierung von asystolen Patienten zu unbefriedigenden Ergebnissen geführt hat. Diese Vermutung muss allerdings im Sinne der evidenzbasierten Medizin durch weitere multizentrisch angelegte Studien mit adaptierten Ein- und Ausschlusskriterien verifiziert werden.
Literatur
1.
Zurück zum Zitat Abu-Laban RB, McIntyre CM, Christenson JM et al (2006) Aminophylline in bradyasystolic cardiac arrest: a randomised placebo-controlled trial. Lancet 367:1577–1584 CrossRefPubMed Abu-Laban RB, McIntyre CM, Christenson JM et al (2006) Aminophylline in bradyasystolic cardiac arrest: a randomised placebo-controlled trial. Lancet 367:1577–1584 CrossRefPubMed
2.
Zurück zum Zitat Bottiger BW, Arntz HR, Chamberlain DA et al (2008) Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med 359:2651–2662 CrossRefPubMed Bottiger BW, Arntz HR, Chamberlain DA et al (2008) Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med 359:2651–2662 CrossRefPubMed
3.
Zurück zum Zitat Bunch TJ, White RD, Gersh BJ et al (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348:2626–2633 CrossRefPubMed Bunch TJ, White RD, Gersh BJ et al (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348:2626–2633 CrossRefPubMed
4.
Zurück zum Zitat Bunch TJ, White RD, Gersh BJ et al (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348(26):2626–2633 CrossRefPubMed Bunch TJ, White RD, Gersh BJ et al (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348(26):2626–2633 CrossRefPubMed
5.
Zurück zum Zitat Callaway CW, Hostler D, Doshi AA et al (2002) Usefulness of vasopressin administered with epinephrine during out-of-hospital cardiac arrest. N Engl J Med 346:549–556 CrossRef Callaway CW, Hostler D, Doshi AA et al (2002) Usefulness of vasopressin administered with epinephrine during out-of-hospital cardiac arrest. N Engl J Med 346:549–556 CrossRef
6.
Zurück zum Zitat Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK (2002) Changing incidence of out-of-hospital ventricular fibrillation, 1980–2000. J Am Med Assoc 288:3008–3013 CrossRef Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK (2002) Changing incidence of out-of-hospital ventricular fibrillation, 1980–2000. J Am Med Assoc 288:3008–3013 CrossRef
7.
Zurück zum Zitat Ditchey RV, Lindenfeld J (1988) Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation 78:382–389 PubMed Ditchey RV, Lindenfeld J (1988) Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation 78:382–389 PubMed
8.
Zurück zum Zitat Fox AW, May RE, Mitch WE (1992) Comparison of peptide and nonpeptide receptor-mediated responses in rat tail artery. J Cardiovasc Pharmacol 20(2):282–289 CrossRefPubMed Fox AW, May RE, Mitch WE (1992) Comparison of peptide and nonpeptide receptor-mediated responses in rat tail artery. J Cardiovasc Pharmacol 20(2):282–289 CrossRefPubMed
9.
Zurück zum Zitat Gottlieb R (1896/97) Über die Wirkung der Nebennieren-Extrakte auf Herz und Blutdruck. Arch Exp Pathol Phramakol 38:99–112 CrossRef Gottlieb R (1896/97) Über die Wirkung der Nebennieren-Extrakte auf Herz und Blutdruck. Arch Exp Pathol Phramakol 38:99–112 CrossRef
10.
Zurück zum Zitat Gueugniaud PY, David JS, Chanzy E et al (2008) Vasopressin and epinephrine vs. Epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 359:21–30 CrossRefPubMed Gueugniaud PY, David JS, Chanzy E et al (2008) Vasopressin and epinephrine vs. Epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 359:21–30 CrossRefPubMed
11.
Zurück zum Zitat Gueugniaud PY, Mols P, Goldstein P et al (1998) A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. N Engl J Med 339:1595–1601 CrossRefPubMed Gueugniaud PY, Mols P, Goldstein P et al (1998) A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. N Engl J Med 339:1595–1601 CrossRefPubMed
12.
Zurück zum Zitat Hallstrom A, Cobb L, Johnson E et al (2000) Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 342:1546–1553 CrossRefPubMed Hallstrom A, Cobb L, Johnson E et al (2000) Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 342:1546–1553 CrossRefPubMed
13.
Zurück zum Zitat Hallstrom A, Rea TD, Sayre MR et al (2006) Manual chest compression vs. use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. J Am Med Assoc 295:2620–2628 CrossRef Hallstrom A, Rea TD, Sayre MR et al (2006) Manual chest compression vs. use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. J Am Med Assoc 295:2620–2628 CrossRef
14.
Zurück zum Zitat Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556 CrossRef Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346:549–556 CrossRef
15.
Zurück zum Zitat Li PF, Chen TT, Zhang JM (1999) Clinical study on administration of vasopressin during closed chest cardiopulmonary resuscitation. Chinese Crit Care Med 11:28–31 Li PF, Chen TT, Zhang JM (1999) Clinical study on administration of vasopressin during closed chest cardiopulmonary resuscitation. Chinese Crit Care Med 11:28–31
16.
Zurück zum Zitat Lienhart HG, Wenzel V, Braun J et al (2007) Vasopressin for therapy of persistent traumatic hemorrhagic shock: the VITRIS at study. Anaesthesist 56:50, 145–148 CrossRef Lienhart HG, Wenzel V, Braun J et al (2007) Vasopressin for therapy of persistent traumatic hemorrhagic shock: the VITRIS at study. Anaesthesist 56:50, 145–148 CrossRef
17.
Zurück zum Zitat Lindner KH, Dirks B, Strohmenger HU et al (1997) Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet 349:535–537 CrossRefPubMed Lindner KH, Dirks B, Strohmenger HU et al (1997) Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet 349:535–537 CrossRefPubMed
18.
Zurück zum Zitat Lindner KH, Haak T, Keller A et al (1996) Release of endogenous vasopressors during and after cardiopulmonary resuscitation. Heart 75:145–150 CrossRefPubMed Lindner KH, Haak T, Keller A et al (1996) Release of endogenous vasopressors during and after cardiopulmonary resuscitation. Heart 75:145–150 CrossRefPubMed
19.
Zurück zum Zitat Lindner KH, Prengel AW, Brinkmann A et al (1996) Vasopressin administration in refractory cardiac arrest. Ann Intern Med 124:1061–1064 PubMed Lindner KH, Prengel AW, Brinkmann A et al (1996) Vasopressin administration in refractory cardiac arrest. Ann Intern Med 124:1061–1064 PubMed
20.
Zurück zum Zitat Lindner KH, Prengel AW, Pfenninger EG et al (1995) Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs. Circulation 91:215–221 PubMed Lindner KH, Prengel AW, Pfenninger EG et al (1995) Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs. Circulation 91:215–221 PubMed
21.
Zurück zum Zitat Lindner KH, Strohmenger HU, Ensinger H et al (1992) Stress hormone response during and after cardiopulmonary resuscitation. Anaesthesiology 77:662–668 CrossRef Lindner KH, Strohmenger HU, Ensinger H et al (1992) Stress hormone response during and after cardiopulmonary resuscitation. Anaesthesiology 77:662–668 CrossRef
22.
Zurück zum Zitat Mally S, Jelatancev A, Grmec S (2007) Effects of epinephrine and vasopressin an end-tidal carbon dioxide tension and mean arterial blood pressure in out-of-hospital cardiopulmonary resuscitation: an observational study. Crit Care 11:R39 CrossRefPubMed Mally S, Jelatancev A, Grmec S (2007) Effects of epinephrine and vasopressin an end-tidal carbon dioxide tension and mean arterial blood pressure in out-of-hospital cardiopulmonary resuscitation: an observational study. Crit Care 11:R39 CrossRefPubMed
23.
Zurück zum Zitat Mentzelopoulos SD, Zakynthinos SG, Tzoufi M et al (2009) Vasopressin, epinephrine and corticosteroids for in-hospital cardiac arrest. Arch Intern Med 169:15–24 CrossRefPubMed Mentzelopoulos SD, Zakynthinos SG, Tzoufi M et al (2009) Vasopressin, epinephrine and corticosteroids for in-hospital cardiac arrest. Arch Intern Med 169:15–24 CrossRefPubMed
24.
Zurück zum Zitat Morris DC, Dereczyk BE, Grzybowski M et al (1997) Vasopressin can increase coronary perfusion pressure during human cardiopulmonary resuscitation. Acad Emerg Med 4:878–883 CrossRefPubMed Morris DC, Dereczyk BE, Grzybowski M et al (1997) Vasopressin can increase coronary perfusion pressure during human cardiopulmonary resuscitation. Acad Emerg Med 4:878–883 CrossRefPubMed
25.
Zurück zum Zitat Mukoyama T, Kinoshita K, Nagao K et al (2009) Effects of vasopressin versus epinephrine in repeated administration for patients undergoing prolonged cardiopulmonary resuscitation. Resuscitation 80:755–715 CrossRefPubMed Mukoyama T, Kinoshita K, Nagao K et al (2009) Effects of vasopressin versus epinephrine in repeated administration for patients undergoing prolonged cardiopulmonary resuscitation. Resuscitation 80:755–715 CrossRefPubMed
26.
Zurück zum Zitat Nifemann JT, Haynes KS, Garner D et al (1986) Postcountershock pulseless rhythms: response to CPR, artificial cardiac pacing, and adrenergic agonists. Ann Emerg Med 15:112–120 CrossRef Nifemann JT, Haynes KS, Garner D et al (1986) Postcountershock pulseless rhythms: response to CPR, artificial cardiac pacing, and adrenergic agonists. Ann Emerg Med 15:112–120 CrossRef
27.
Zurück zum Zitat Paradis NA, Knaut A, Halperin H (2002) Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med 347:1281–1282 CrossRefPubMed Paradis NA, Knaut A, Halperin H (2002) Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med 347:1281–1282 CrossRefPubMed
28.
Zurück zum Zitat Prengel AW, Lindner KH, Keller A (1996) Cerebral oxygenation during cardiopulmonary resuscitation with epinephrine and vasopressin in pigs. Stroke 27:1241–1248 PubMed Prengel AW, Lindner KH, Keller A (1996) Cerebral oxygenation during cardiopulmonary resuscitation with epinephrine and vasopressin in pigs. Stroke 27:1241–1248 PubMed
29.
Zurück zum Zitat Riou B, Landais P, Vivien B et al (2001) Distribution of the probability of survival is a strategic issue for randomized trials in critically ill patients. Anesthesiology 95:56–63 CrossRefPubMed Riou B, Landais P, Vivien B et al (2001) Distribution of the probability of survival is a strategic issue for randomized trials in critically ill patients. Anesthesiology 95:56–63 CrossRefPubMed
30.
Zurück zum Zitat Schultz CH, Rivers EP, Feldkamp CS et al (1993) A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit Care Med 21:1339–1347 CrossRefPubMed Schultz CH, Rivers EP, Feldkamp CS et al (1993) A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit Care Med 21:1339–1347 CrossRefPubMed
31.
Zurück zum Zitat Stiell IG, Hebert PC, Wells GA et al (2001) Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial. Lancet 358:105–109 CrossRefPubMed Stiell IG, Hebert PC, Wells GA et al (2001) Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial. Lancet 358:105–109 CrossRefPubMed
32.
Zurück zum Zitat Stiell IG, Walker RG, Nesbitt LP et al (2007) BIPHASIC Trial: a randomized comparison of fixed lower versus escalating higher energy levels for defibrillation in out-of-hospital cardiac arrest. Circulation 115:1511–1517 CrossRefPubMed Stiell IG, Walker RG, Nesbitt LP et al (2007) BIPHASIC Trial: a randomized comparison of fixed lower versus escalating higher energy levels for defibrillation in out-of-hospital cardiac arrest. Circulation 115:1511–1517 CrossRefPubMed
33.
Zurück zum Zitat Strohmenger HU, Lindner KH, Keller A et al (1995) Concentrations of prolactin and prostaglandins during and after cardiopulmonary resuscitation. Crit Care Med 23:1347–1355 CrossRefPubMed Strohmenger HU, Lindner KH, Keller A et al (1995) Concentrations of prolactin and prostaglandins during and after cardiopulmonary resuscitation. Crit Care Med 23:1347–1355 CrossRefPubMed
34.
Zurück zum Zitat Tang W, Weil MH, Gazmuri RJ et al (1991) Pulmonary ventilation/perfusion defects induced by epinephrine during cardiopulmonary resuscitation. Circulation 84:2101–2107 PubMed Tang W, Weil MH, Gazmuri RJ et al (1991) Pulmonary ventilation/perfusion defects induced by epinephrine during cardiopulmonary resuscitation. Circulation 84:2101–2107 PubMed
35.
Zurück zum Zitat Tang W, Weil MH, Sun S et al (1995) Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation 92:3089–3093 PubMed Tang W, Weil MH, Sun S et al (1995) Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation 92:3089–3093 PubMed
36.
Zurück zum Zitat Wenzel V, Krismer AC, Arntz HR et al (2004) A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 350:105–113 CrossRefPubMed Wenzel V, Krismer AC, Arntz HR et al (2004) A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 350:105–113 CrossRefPubMed
37.
Zurück zum Zitat Wenzel V, Lindner KH, Krismer AC et al (1999) Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prologed cardiopulmonary resuscitation in pigs. Circulation 99:1379–1384 PubMed Wenzel V, Lindner KH, Krismer AC et al (1999) Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prologed cardiopulmonary resuscitation in pigs. Circulation 99:1379–1384 PubMed
38.
Zurück zum Zitat Wenzel V, Lindner KH, Prengel AW et al (1999) Vasopressin improves vital organ blood flow after prolonged cardiac arrest with postcountershock pulseless electrical activity in pigs. Crit Care Med 27:486–492 CrossRefPubMed Wenzel V, Lindner KH, Prengel AW et al (1999) Vasopressin improves vital organ blood flow after prolonged cardiac arrest with postcountershock pulseless electrical activity in pigs. Crit Care Med 27:486–492 CrossRefPubMed
39.
Zurück zum Zitat Wenzel V, Padosch SA, Lindner KH (1998) Vasopressin als alternativer Vasopressor bei der kardiopulmonalen Reanimation. Dtsch Med Wochenschr 123:877–882 CrossRefPubMed Wenzel V, Padosch SA, Lindner KH (1998) Vasopressin als alternativer Vasopressor bei der kardiopulmonalen Reanimation. Dtsch Med Wochenschr 123:877–882 CrossRefPubMed
40.
Zurück zum Zitat Wik L, Hansen TB, Fylling F et al (2003) Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial. J Am Med Assoc 289:1389–1395 CrossRef Wik L, Hansen TB, Fylling F et al (2003) Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial. J Am Med Assoc 289:1389–1395 CrossRef
41.
Zurück zum Zitat Wik L, Kramer-Johansen J, Myklebust H et al (2005) Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. J Am Med Assoc 293:299–304 CrossRef Wik L, Kramer-Johansen J, Myklebust H et al (2005) Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. J Am Med Assoc 293:299–304 CrossRef
42.
Zurück zum Zitat Wolcke BB, Mauer DK, Schoefmann MF et al (2003) Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest. Circulation 108:2201–2205 CrossRefPubMed Wolcke BB, Mauer DK, Schoefmann MF et al (2003) Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest. Circulation 108:2201–2205 CrossRefPubMed
43.
Zurück zum Zitat Zipes DP, Wellens HJ (1998) Sudden cardiac death. Circulation 98:2334–2351 PubMed Zipes DP, Wellens HJ (1998) Sudden cardiac death. Circulation 98:2334–2351 PubMed
Metadaten
Titel
Vasopressoren bei der kardiopulmonalen Reanimation
Möglichkeiten und Grenzen
verfasst von
J. Kreutziger
P.-P. Ellmauer
K.H. Lindner
M.Sc. Prof. Dr. V. Wenzel
Publikationsdatum
01.06.2010
Verlag
Springer-Verlag
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 4/2010
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-010-1283-1

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