Is there still a place for vasopressors in the treatment of cardiac arrest?

The role of vasopressors during resuscitation from cardiac arrest needs to be further investigated. In experimental models, vasopressors increase diastolic blood pressure and blood flow to vital organs during CPR and facilitate resuscitation but also have detrimental effects on post-resuscitation myocardial performance and cerebral circulation. Two recent controlled trials in out-of-hospital cardiac arrest patients demonstrated that administration of epinephrine and other drugs was asso-ciated with a significant increase in short-term survival but not in survival to hospital discharge. In one of those trials, patients in the epinephrine group had more than twice the odds of surviving to hospital discharge than those who received placebo, but the difference did not reach statistical significance, possibly because of inade-quate sample size. Future placebo-controlled trials on larger populations are needed to assess more clearly the association between epinephrine and survival to hospital discharge. Clinical studies are also needed to investigate the occurrence of side effects from vasopressors in humans after resuscitation and their possible influence on hospital survival.