Combination therapy may help improve rate of favorable neurological status following cardiac arrest

Among patients who experienced in-hospital cardiac arrest requiring vasopressors (drugs that increase blood pressure), use of a combination therapy during cardiopulmonary resuscitation resulted in improved survival to hospital discharge with favorable neurological status, according to a study in the July 17 issue of JAMA.

"Neurological outcome after cardiac arrest has been the main end point of several (RCTs). Neurologically favorable survival differs from overall survival. Among cardiac arrest survivors, the prevalence of severe cerebral disability or ranges from 25 percent to 50 percent. In a previous single-center RCT, combined vasopressin-epinephrine during cardiopulmonary (CPR) and corticosteroid supplementation during and after CPR vs. epinephrine [adrenaline] alone during CPR and no steroids resulted in improved overall survival to hospital discharge," according to background information in the article. "However, this preliminary study could not reliably assess vasopressin-steroids-epinephrine (VSE) efficacy with respect to neurologically favorable survival to hospital discharge."

Spyros D. Mentzelopoulos, M.D., Ph.D., of the University of Athens Medical School, Athens, Greece, and colleagues conducted a study to determine whether combined vasopressin-epinephrine during CPR and corticosteroid supplementation during and after CPR improved survival to hospital discharge with a favorable neurological score on the Cerebral Performance Category (CPC). The randomized, placebo- was performed from September 2008 to October 2010 in 3 tertiary care centers in Greece and included 268 patients with cardiac arrest requiring epinephrine according to resuscitation guidelines.

Patients received either vasopressin plus epinephrine (VSE group, n = 130) or saline placebo plus epinephrine (control group, n = 138) for the first 5 CPR cycles after randomization, followed by additional epinephrine if needed. During the first CPR cycle after , patients in the VSE group received methyl prednisolone and patients in the control group received saline placebo. Shock after resuscitation was treated with stress-dose hydrocortisone (VSE group, n = 76) or saline placebo (control group, n = 73). The primary outcomes for the study were return of spontaneous circulation (ROSC) for 20 minutes or longer and survival to hospital discharge with a CPC score of 1 or 2.

Patients in the VSE group had a higher probability for ROSC for 20 minutes or longer compared with patients in the control group (109/130 [83.9 percent] vs. 91/138 [65.9 percent]). Compared with patients in the control group, patients in the VSE group had a lower risk of poor outcome during follow-up and were more likely to be alive at hospital discharge with favorable neurological recovery (18/130 [13.9 percent] vs. 7/138 [5.1 percent]).

Among survivors for 4 hours or longer, VSE patients with postresuscitation shock (n = 76) vs. corresponding controls (n = 73) had a lower risk of poor outcome during follow-up and were more likely to be alive at hospital discharge with favorable neurological recovery (16/76 [21.1 percent] vs. 6/73 [8.2 percent]).

Post-arrest illness and complications throughout hospital stay and death causes were similar among survivors for 4 hours or longer.

"In this study of patients with cardiac arrest requiring vasopressors, the combination of vasopressin and epinephrine, along with methylprednisolone during CPR and hydrocortisone in postresuscitation shock, resulted in improved survival to with favorable , compared with epinephrine and saline placebo. These results are consistent with increased efficacy of the VSE combination vs. epinephrine alone during CPR for in-hospital, vasopressor-requiring ," the authors write.

More information: JAMA. 2013;310(3):270-279

add to favorites email to friend print save as pdf

Related Stories

Adrenaline use in cardiac arrest

Jul 26, 2011

Adrenaline has kept its place in cardiac arrest guidelines despite limited evidence for or against its use. The PACA (Placebo versus Adrenaline versus Cardiac Arrest) study by Jacobs and colleagues, soon to be published in ...

Longer CPR extends survival in both children and adults

Jan 21, 2013

Experts from The Children's Hospital of Philadelphia were among the leaders of two large national studies showing that extending CPR longer than previously thought useful saves lives in both children and adults. The research ...

Recommended for you

ASHG: MI without substantial CAD is minimally heritable

Oct 21, 2014

(HealthDay)—The presence of myocardial infarction (MI) without substantial coronary artery disease (CAD) is not familial, according to a study presented at the annual meeting of the American Society of ...

User comments