Is vasopressin superior to adrenaline or placebo in the management of cardiac arrest? A meta-analysis Giuseppe G.L. Biondi-Zoccai a, *, Antonio Abbate a , Quintino Parisi a , Pierfrancesco Agostoni b , Francesco Burzotta a , Claudio Sandroni c , Piero Zardini b , Luigi M. Biasucci a a Institute of Cardiology, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy b Institute of Cardiology, University of Verona, Verona, Italy c Institute of Anesthesiology and Intensive Care, Catholic University, Rome, Italy Received 21 May 2003; received in revised form 1 June 2003; accepted 17 June 2003 Abstract Vasopressin is currently recommended in the management of patients with cardiac arrest, but its efficacy is still incompletely established. We systematically reviewed randomized trials comparing vasopressin to control treatment in the management of cardiac arrest in humans and animals. Two human and 33 animal studies were retrieved. At pooled analysis vasopressin appeared equivalent to adrenaline (epinephrine) in the management of human cardiac arrest (N /240), with, respectively 63 (78/124) vs 59% (68/116) ROSC (P /0.43), and 16 (20/124) vs 14% (16/116) survival to hospital discharge (P /0.52). In animal trials (N /669) vasopressin appeared instead significantly superior to both placebo (ROSC, respectively 93 [98/105] vs 19% [14/72], P B/0.001) or adrenaline (ROSC, respectively 84 [225/268] vs 52% [117/224], P B/0.001). In conclusion, vasopressin is superior to both placebo or adrenaline in animal models of cardiopulmonary resuscitation. Evidence in humans is still limited and confidence intervals estimates too wide to reliably confirm or disprove results obtained in experimental animal settings. # 2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Advanced life support (ALS); Cardiac arrest; Epinephrine; Vasopressin; Vasopressor therapy; Meta-analysis Resumo A vasopressina e ´, actualmente, recomendada no tratamento de doentes com paragem cardı ´aca, mas a sua efica ´cia ainda na ˜o esta ´ completamente estabelecida. Fizemos uma revisa ˜o sistema ´tica de estudos randomizados comparando a vasopressina ao tratamento de controlo da paragem cardı ´aca em humanos e animais. Foram revistos dois estudos com humanos e 33 com animais. Numa ana ´lise conjunta a vasopressina mostrou-se equivalente a ` adrenalina (epinefrina) no manuseio da paragem cardı ´aca (N /240), com Recuperac ¸a ˜o da circulac ¸a ˜o esponta ˆnea (ROSC) em respectivamente 63 (78/124) vs 59% (68/116) (P /0.43) e sobrevida ate ´ alta hospitalar de 16 (20/124) vs 14% (16/116) (P /0.52). Em estudos animais (N /669), a vasopressina mostrou-se significativamente superior ao placebo (ROSC, respectivamente 93 (98/105) vs 19% (14/72), P B/0.001) ou a ` adrenalina (ROSC, respectivamente 84 (225/268) vs 52% (117/224), P B/0.001). Em conclusa ˜o, a vasopressina e ´ superior ao placebo ou a ` adrenalina em modelos animais de reanimac ¸a ˜o cardio-pulmonar. Pelo contra ´rio, a evide ˆncia em humanos ainda e ´ limitada e os intervalos de confianc ¸a estimados demasiado largos para confirmar ou desmentir com confianc ¸a os resultados obtidos em ambiente de experimentac ¸a ˜o animal. # 2003 Elsevier Ireland Ltd. All rights reserved. Palavras chave: Suporte de vida avanc ¸ado (SAV); Paragem cardı ´aca; Epinefrina; Vasopressina; Terape ˆutica vasopressora; Meta-ana ´lise * Corresponding author. Tel.:  /39-06-3408626829; fax:  /39-06-1786015115. E-mail address: gbiondizoccai@tiscali.it (G.G.L. Biondi-Zoccai). Resuscitation 59 (2003) 221  /224 www.elsevier.com/locate/resuscitation 0300-9572/03/$ - see front matter # 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0300-9572(03)00234-X