Comparing Vasopressin and Adrenaline in Patients With Cardiac Arrest (PIVOT)

Singapore Health Services (SingHealth)

Status and phase: Completed; Phase 3

Conditions: Cardiac Arrest

Treatments: Drug: Adrenaline; Drug: Vasopressin

Study type: Interventional

Funder types: Other

Identifiers

NCT00358579

SQCA01

Details and patient eligibility

About

The effectiveness of medications in cardiac arrest has been greatly debated and questioned. Historically intravenous adrenaline has been the drug of choice since 1906. There have been few formal evaluations to determine the value of adrenaline for cardiac arrest, and clinical trials have not been able to show any benefit with intravenous adrenaline (compared to placebo or no treatment) in the field.

Thus the purpose of this study is to compare vasopressin and adrenaline in the treatment of cardiac arrest to answer the question whether there is an improvement in survival between vasopressin and adrenaline.

Full description

The effectiveness of medications in cardiac arrest has been greatly debated and questioned. Historically intravenous adrenaline has been the recommended drug of choice since 1906. There have been few formal evaluations to determine the value of adrenaline for cardiac arrest, and clinical trials have not been able to show any benefit with intravenous adrenaline (compared to placebo or no treatment) in the field.

More recently, vasopressin has been used in patients with cardiac arrest. In human studies on vasopressin, clinical trials have produced conflicting results.

The current study compared vasopressin and adrenaline in the treatment of cardiac arrest in patients presenting to the Emergency Department (ED). Specific outcomes included return of spontaneous circulation (ROSC) (as measured by the presence of a palpable pulse at any time during resuscitation), survival to hospital admission, survival to discharge from hospital, and functional status at discharge and at one year (as measured by the Glasgow-Pittsburgh outcome categories).

Enrollment: 727 patients

Sex: All

Ages: 17+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patient with cardiac arrest as confirmed by the absence of a pulse, unresponsiveness and apnea
• Age above 16 (Age 21 and above for CGH only)

Exclusion criteria

• Traumatic cardiac arrest
• Age 16 and below (Age 20 and below for CGH only)
• CPR is contraindicated

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

---

727 participants in 2 patient groups

Adrenaline

Active Comparator group

Treatment:

Drug: Adrenaline

Vasopressin

Active Comparator group

Treatment:

Drug: Vasopressin