The role of vasopressin and terlipressin in catecholamine-resistant shock and cardio-circulatory arrest in children: review of the literature.

INTRODUCTION: Arginine-vasopressin (AVP) and terlipressin (TP) are used as rescue drugs for states of shock and cardio-circulatory failure.

METHODS: Review to assess AVP/TP as a rescue therapy in children with catecholamine-resistant shock or cardio-circulatory arrest.

RESULTS: A total of 31 reports were included (428 patients); sixteen articles were case series, 10 case reports, 3 clinical evaluation studies, one study was a non-blind RCT while one study was a multicentre double-blind RCT. The most common indication for either drug was catecholamine-refractory septic shock (12 reports). Commonly reported responses following AVP/TP administration were a rapid increase in blood pressure, an increase in urine output, and a decrease in serum lactate. In most reports, AVP and TP led to the reduction of catecholamines. The cumulative mortality rate remained high (188/428; 43.9%) despite the use of AVP/TP.

CONCLUSIONS: No firm recommendations on the use of AVP/TP in children with severe forms of cardio-circulatory failure can be issued.