Vasopressin in advanced cardiac life support?

Critical Care Providers’ Perceptions of the Use of Vasopressin in Cardiac Arrest

• Background Although published algorithms and guidelines list epinephrine and vasopressin as either/or choices for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, little is known about how critical care providers respond to this recommendation.

• Objectives To assess the use of vasopressin as a first-line drug of choice for ventricular fibrillation and/or pulseless ventricular tachycardia and describe factors that may influence decision making for using vasopressin.

• Methods A convenience sample from 4 academic medical centers in the United States was recruited to complete a 20-item survey on demographic factors such as year of last Advanced Cardiac Life Support (ACLS) provider course, specialty certification, predominant practice responsibility, and beliefs related to the use of vasopressin for cardiac arrest. Descriptive statistics, Pearson correlation analysis, and logistic regression were used to analyze the data.

• Results A total of 214 critical care providers (80% registered nurses) completed the survey. Year of last ACLS course (r = −0.188, P = .006) was a significant demographic factor, and behavioral beliefs (attitude about using vasopressin) had the strongest relationship (r = 0.687, P < .001) and were the best predictor for intentions to use or recommend the use of vasopressin (beta=0.589, P<.001).

• Conclusions Despite the recommendation for vasopressin as an agent equivalent to epinephrine for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, 63% of respondents used epinephrine as a first-line drug of choice. More research is needed to address the classification system for interpreting the quality of evidence that may influence practice.