Combination Treatment Beneficial for Cardiac Arrest
(HealthDay News) – Among patients with cardiac arrest requiring vasopressors, treatment with epinephrine, vasopressin, and methylprednisolone during cardiopulmonary resuscitation (CPR) leads to improved survival to hospital discharge and improved neurological status, according to a study published in the July 17 issue of the Journal of the American Medical Association.
Spyros D. Mentzelopoulos, MD, PhD, from the University of Athens Medical School in Greece, and colleagues randomly assigned 268 patients with cardiac arrest requiring epinephrine to vasopressin plus epinephrine plus methylprednisolone (VSE group) or saline placebo plus epinephrine (control group) during CPR. Shock after resuscitation was treated with stress-dose hydrocortisone for the VSE group and with saline placebo for the control group.
The researchers found that the VSE group was significantly more likely to have a return of spontaneous circulation for ≥20 minutes (83.9% vs. 65.9%; odds ratio, 2.98) and survive to hospital discharge with a Cerebral Performance Category (CPC) score of 1 or 2 (13.9% vs. 5.1%; odds ratio, 3.28). Of patients with post-resuscitation shock, the VSE group was also more likely to survive to hospital discharge with CPC scores of 1 or 2, have improved hemodynamics and central venous oxygen saturation, and have less organ dysfunction. The two groups had similar rates of adverse events, according to the study.
"Among patients with cardiac arrest requiring vasopressors, combined vasopressin-epinephrine and methylprednisolone during CPR and stress-dose hydrocortisone in post-resuscitation shock, compared with epinephrine/saline placebo, resulted in improved survival to hospital discharge with favorable neurological status," Mentzelopoulos and colleagues conclude.