Vasopressin vs. Epi

ernurse728, LPN · Oct 2, 2002

Same here...we never use vasopressin in codes, always epi. I am due to re-test for ACLS in a few months so I will be interestd to see if that is what they are teaching now. As for amiodarone we use it...just not as often as we should be. Our docs still want to use lidocaine...as well as EMS crews.

rstewart · Oct 2, 2002

When I am running codes I always select vasopressin initially rather than the epi; although we teach that either drug is acceptable, vasopressin is classified as a 2b intervention while the epi is class indeterminant.

As a non physician I must follow the approved algorithms; ours specifies amiodarone before lidocaine. Again, the strength of evidence favors amiodarone (class 2b) over lidocaine (class indeterminant).

By now both drugs should be stocked on your code carts in my opinion. It should be stressed that ACLS algorithms are guidelines and not standards of care; on the other hand, at this point there is sparce evidence supporting the efficiency of either lidocaine or epi.

I was surprised to read the comment that any EMS crews still prefer lidocaine. For out of hospital arrests it appears that amiodarone does marginally improve ones chances of survival to the hospital at least.

KC CHICK · Oct 2, 2002

I have a question about vasopressin vs. epi.

During a code, I know epi only has to be pumped for a minute before giving it again. Am I correct in saying that vasopressin has to be pumped for 10 min before another drug is used? Would that be why the drug is avoided, perhaps?

10 min is a very long time in a code situation.

Anne

NOAH'SDAD · Oct 2, 2002

I just renewed my ACLS certification and the AHA is recommending using vasopressin X 1 then waiting 10-20 minutes before trying epi. So if you use vasopressin you really seem to limit your options, but if research shows that it works better then I would definetly try it. As far as lido vs. amiodarone, maybe emt's don't like amiodarone as much because your supposed to dilute it, which takes time. Either way I would like to see any research that favors one over the other. Whatever produces the best outcomes works for me

rstewart · Oct 2, 2002

Before attempting to answer your question once again I must stress that I teach using ACLS guidelines/recommendations; they are not standards of care.

That said, a physician can dose epinephrine however he or she chooses within reason. If the docs at your facility give epi doses a minute apart or two together for that matter, that is their right. The current guidelines call for epi to be given 1mg Q 3-5 minutes; normally the patient is defibrillated 30-60 seconds after each dose.

The recommendation for vasopressin is 40 units to be given one time. Now the half life for vasopressin (10-20 minutes) is much longer than epi. But there is no guideline that says you may not give additional shocks or drugs until that 10-20 minute period expires. In fact, after the defibrillation post vasopressin administration you would begin giving your antiarrythmics beginning with amiodarone in a drug shock drug shock sequence. If the vasopressin was unsuccessful, most ACLS experts recommend initiating epi Q3-5 minutes 10-20 minutes after the vasopressin was given. So no, that is not a reason why vasopressin is not being utilized.

KC CHICK · Oct 2, 2002

Let me correct myself...you're right. Epi is 3-5 min apart. Duh!! Don't know what I was thinking.

But, isn't 10-20 minutes a LONG time to wait to give epi? 3-5 min seems long enough already when you're pumping on someone's chest.

Anne

neneRN, BSN, RN · Oct 3, 2002

We had a little lady with bilat PEs today, coded her 6 times before we could get her down to vasc lab- literally depleted two code carts of epi. I asked the doc afterwards about vasopressin, and she replied that she didn't know enough about it to feel comfortable using it in a code, but would research it to possibly start using it. So maybe it is just that simple, they stick with what they know?

psychomachia · Oct 3, 2002

NOAH'SDAD: As far as lido vs. amiodarone, maybe emt's don't like amiodarone as much because your supposed to dilute it, which takes time.

Me: Here is a link to the NEJM article: Amiodarone comparison with Lidocaine .

Besides the administration difficulty, the cost of amiodarone is also a factor for EMS systems when deciding which drug to use.

NOAH'SDAD · Oct 3, 2002

Thanks for the link, a very intersting study. I'm sure its only a matter of time before the amiodarone people make an easier version to administer.

Coldfoot · Oct 3, 2002

I know of a couple reasons it's not being used pre-hospital as much as it should/could. The biggest is cost. The fact that it is not packaged as a preload also works against it. One of my former medical directors made the case that,at the time,(I'm not sure if this is still true) all studies in regards to pre-hospital amiodorone were stopped at admission to the ER, not to final pt outcome. His argument was that untill it was shown to decrease morbitity/mortality rates we were not going to use it.

Just my 2 cents:p

JE1RN · Oct 4, 2002

VASO VS EPI I FEEL LIKE THE BIGGEST REASON VASOPRESSIN ISNT USED MORE IS BECAUSE IN GENERAL;"WE" ARE MORE COMFTERABLE WITH

'WHAT WE KNOW" AND THE FACT THAT 10 MINS IS A LONG TIME AFTER GIVING A DRUGTO SEE RESULTS.

I HAVE ONLY USED VASO. 1 TIME WHEN IT WAS SUGGESTED NO ONE WAS EXACTLY SURE THE RIGHT AMOUNT WE HAD TO LOOK IT UP WHICH ALSO LEADS TO FRUSTATION.WE HAD GIVEN ABOUT 2 CODE CARTS IV THE IND. WOULD GO FROM VT-VF-PEA AFTER ABOUT 25 MINS AND SHOCKING TO MANY TIMES TO COUNT WE TRIED VASO. IT WORKED IT TOOK ABOUT 5-10 MINS JUST AS WE WERE ABOUT TO CALL IT WE FELT A PULSE SO WHO KNOWS MAYBE WE SHOULD ALL TRY IT FIRST. AMIODERONE WE USE THIS ALL THE TIME RARLEY DO WE USE LIDO.AND DURING A CODE SITUTATION YOU JUST PUSH IT WE DONT DILUTE NEVER HAD A PROBLEM