Objective: Our objective was to compare the effects of combination of vasopressin and epinephrine with epinephrine alone on rates of return of spontaneous circulation (ROSC) and mortality in children with in- ospital cardiopulmonary arrest (CPA). Methods: This was a retrospective chart review of children with cardiac arrest admitted to the Pediatric intensive care unit (ICU) of a tertiary care hospital in North India between May and July 2012. The study period was divided into two intervals- period 1 where only epinephrine was used and period 2 where a single dose of vasopressin was used at a dose of 0.8u/kg in addition to epinephrine. Children were resuscitated as per the 2010 AHA guidelines for cardiopulmonary resuscitation (CPR) during both time periods. Data regarding baseline characteristics, clinical course and predetermined clinical outcomeswere recorded in a pre-structured proforma. Data was entered into Microsoft excel and analyzed using Stata 11. Results: A total of 28 case records of children with CPA were retrieved during the study period. Of these only 6 (21%) children survived to hospital discharge while the remaining children (n= 22, 19%) succumbed to their illnesses. A total of 14 children each were enrolled during the two time periods. The most common reasons for ICU admission as well as mortality were severe sepsis and septic shock seen in almost all (n=14) the children in period 1 and 85% (n=12) of the children in period 2. Compared to period 1 children from period 2 were sicker at admission with higher mortality risk scores(p=0.03) higher incidence of tachyarrhythmia and of refractory shock. Almost 50% (n=7) of the children receiving vasopressin as the second drug had ROSCimmediately after the arrest in comparison to 43% (n=6) of children receiving epinephrine alone. At 24 hours however, only 5(35%) and 4 (28.6%) of these children from period 2 and period 1 respectively were found to be surviving. Ultimately only 2 children (14%) from period 2 and 4 children (28.6) from period 1 survived to hospital discharge. The differences between the two time periods with respect to all of these primary outcomes were statistically insignificant (p>0.05). Conclusion: Use of vasopressin as an add-on drug during CPR did not seem to affect the clinical outcomes of children with in-hospital cardiac arrest in comparison to the standard practice of using epinephrine alone. 

Key words: CPR; Cardiopulmonary resuscitation; Vasopressin; Epinephrine, In- ospital cardiac arrest.