Best Evidence Topics
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The use of vasopressin and epinephrine for patients in cardiac arrest due to local anaesthetic toxicity.

Three Part Question

In [adults with local anaesthetic toxicity in cardiac arrest] is [vasopressin better than epinephrine] at [reducing morbidity and mortality]?

Clinical Scenario

Clinical Scenario A thirty-three year old male is goes into cardiac arrest after an accidental overdoes of tetracaine. Which drug would be most effective in the resuscitation of this patient?

Search Strategy

Using Ovid interface; Medline 1950 to June week 4 2010, Embase 1980 to 2010 week 26, Cochrane database of systematic reviews 2005 May 2010
[exp Anesthesia, Local/ OR (local adj1 anaesthe$).mp OR exp Anesthetics, Local/ OR exp bupivacaine/ OR bupivacaine$.mp. OR lidocaine/ OR lidocaine$.mp. OR exp prilocaine/ OR prilocaine$.mp. OR exp lignocaine/ OR lignocaine$.mp. OR marcaine$.mp.] AND [exp heart arrest/] AND [exp vasopressins/ OR exp epinephrine/] LIMIT to English language and humans.

Search Outcome

570 papers 0 of which were relevant


No papers were found that compared vasopressin and epinephrine. There were case reports where epinephrine had been used for resuscitation in cardiac arrest due to local anaesthetic toxicity; as these did not compare vasopressin they are not relevant to the clinical question. There is no evidence for the use of vasopressin over epinephrine.

Clinical Bottom Line

No evidence vasopressin is superior to epinephrine in those patients in cardiac arrest due to local anaesthetic toxicity. Continue standard cardiac arrest protocol.