Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation

Lancet. 1997 Feb 22;349(9051):535-7. doi: 10.1016/S0140-6736(97)80087-6.


Background: Studies in animals have suggested that intravenous vasopressin is associated with better vital-organ perfusion and resuscitation rates than is epinephrine in the treatment of cardiac arrest. We did a randomised comparison of vasopressin with epinephrine in patients with ventricular fibrillation in out-of-hospital cardiac arrest.

Methods: 40 patients in ventricular fibrillation resistant to electrical defibrillation were prospectively and randomly assigned epinephrine (1 mg intravenously; n = 20) or vasopressin (40 U intravenously; n = 20) as primary drug therapy for cardiac arrest. The endpoints of this double blind study were successful resuscitation (hospital admission), survival for 24 h, survival to hospital discharge and neurological outcome (Glasgow coma scale). Analyses were by intention to treat.

Findings: Seven (35%) patients in the epinephrine group and 14 (70%) in the vasopressin group survived to hospital admission (p = 0.06). At 24 h, four (20%) epinephrine-treated patients and 12 (60%) vasopressin-treated patients were alive (p = 0.02). Three (15%) patients in the epinephrine group and eight (40%) in the vasopressin group survived to hospital discharge (p = 0.16). Neurological outcomes were similar (mean Glasgow coma score at hospital discharge 10.7 [SE 3.8] vs 11.7 [1.6], p = 0.78).

Interpretation: In this preliminary study, a significantly larger proportion of patients created with vasopressin than of those treated with epinephrine were resuscitated successfully from out-of-hospital ventricular fibrillation and survived for 24 h. Based upon these findings, larger multicentre studies of vasopressin in the treatment of cardiac arrest are needed.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Double-Blind Method
  • Electric Countershock
  • Emergency Medical Services*
  • Epinephrine / therapeutic use*
  • Female
  • Heart Arrest / drug therapy*
  • Heart Arrest / etiology
  • Heart Arrest / therapy
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Resuscitation / methods*
  • Vasopressins / therapeutic use*
  • Ventricular Fibrillation / complications
  • Ventricular Fibrillation / drug therapy*


  • Vasopressins
  • Epinephrine