Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest. Export

@article{citeulike:5955187, abstract = {BACKGROUND: Animal data on cardiac arrest showed improved long-term survival with combined vasopressin-epinephrine. In cardiac arrest, cortisol levels are relatively low during and after cardiopulmonary resuscitation. We hypothesized that combined vasopressin-epinephrine and corticosteroid supplementation during and after resuscitation may improve survival in refractory in-hospital cardiac arrest. METHODS: We conducted a single-center, prospective, randomized, double-blind, placebo-controlled, parallel-group trial. We enrolled 100 consecutive patients with cardiac arrest requiring epinephrine according to current resuscitation guidelines. Patients received either vasopressin (20 IU per cardiopulmonary resuscitation cycle) plus epinephrine (1 mg per resuscitation cycle) (study group; n = 48) or isotonic sodium chloride solution placebo plus epinephrine (1 mg per resuscitation cycle) (control group; n = 52) for the first 5 resuscitation cycles after randomization, followed by additional epinephrine if needed. On the first resuscitation cycle, study group patients received methylprednisolone sodium succinate (40 mg) and controls received saline placebo. Postresuscitation shock was treated with stress-dose hydrocortisone sodium succinate (300 mg daily for 7 days maximum, with gradual taper) (27 patients in the study group) or saline placebo (15 patients in the control group). Primary end points were return of spontaneous circulation for 15 minutes or longer and survival to hospital discharge. RESULTS: Study group patients vs controls had more frequent return of spontaneous circulation (39 of 48 patients [81\%] vs 27 of 52 [52\%]; P = .003) and improved survival to hospital discharge (9 [19\%] vs 2 [4\%]; P = .02). Study group patients with postresuscitation shock vs corresponding controls had improved survival to hospital discharge (8 of 27 patients [30\%] vs 0 of 15 [0\%]; P = .02), improved hemodynamics and central venous oxygen saturation, and more organ failure-free days. Adverse events were similar in the 2 groups. CONCLUSION: In this single-center trial, combined vasopressin-epinephrine and methylprednisolone during resuscitation and stress-dose hydrocortisone in postresuscitation shock improved survival in refractory in-hospital cardiac arrest. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00411879.}, author = {Mentzelopoulos, Spyros D. and Zakynthinos, Spyros G. and Tzoufi, Maria and Katsios, Nikos and Papastylianou, Androula and Gkisioti, Sotiria and Stathopoulos, Anastasios and Kollintza, Androniki and Stamataki, Elissavet and Roussos, Charis}, citeulike-article-id = {5955187}, citeulike-linkout-0 = {http://dx.doi.org/10.1001/archinternmed.2008.509}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19139319}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19139319}, day = {12}, doi = {10.1001/archinternmed.2008.509}, issn = {1538-3679}, journal = {Archives of internal medicine}, keywords = {2009, cardiac\_arrrest, corticosteroids, epinephrine, vasopressin}, month = {January}, number = {1}, pages = {15--24}, posted-at = {2009-10-17 03:25:18}, priority = {2}, title = {Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest.}, url = {http://dx.doi.org/10.1001/archinternmed.2008.509}, volume = {169}, year = {2009} }

TY - JOUR ID - citeulike:5955187 L3 - citeulike-article-id:5955187 N2 - BACKGROUND: Animal data on cardiac arrest showed improved long-term survival with combined vasopressin-epinephrine. In cardiac arrest, cortisol levels are relatively low during and after cardiopulmonary resuscitation. We hypothesized that combined vasopressin-epinephrine and corticosteroid supplementation during and after resuscitation may improve survival in refractory in-hospital cardiac arrest. METHODS: We conducted a single-center, prospective, randomized, double-blind, placebo-controlled, parallel-group trial. We enrolled 100 consecutive patients with cardiac arrest requiring epinephrine according to current resuscitation guidelines. Patients received either vasopressin (20 IU per cardiopulmonary resuscitation cycle) plus epinephrine (1 mg per resuscitation cycle) (study group; n = 48) or isotonic sodium chloride solution placebo plus epinephrine (1 mg per resuscitation cycle) (control group; n = 52) for the first 5 resuscitation cycles after randomization, followed by additional epinephrine if needed. On the first resuscitation cycle, study group patients received methylprednisolone sodium succinate (40 mg) and controls received saline placebo. Postresuscitation shock was treated with stress-dose hydrocortisone sodium succinate (300 mg daily for 7 days maximum, with gradual taper) (27 patients in the study group) or saline placebo (15 patients in the control group). Primary end points were return of spontaneous circulation for 15 minutes or longer and survival to hospital discharge. RESULTS: Study group patients vs controls had more frequent return of spontaneous circulation (39 of 48 patients [81%] vs 27 of 52 [52%]; P = .003) and improved survival to hospital discharge (9 [19%] vs 2 [4%]; P = .02). Study group patients with postresuscitation shock vs corresponding controls had improved survival to hospital discharge (8 of 27 patients [30%] vs 0 of 15 [0%]; P = .02), improved hemodynamics and central venous oxygen saturation, and more organ failure-free days. Adverse events were similar in the 2 groups. CONCLUSION: In this single-center trial, combined vasopressin-epinephrine and methylprednisolone during resuscitation and stress-dose hydrocortisone in postresuscitation shock improved survival in refractory in-hospital cardiac arrest. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00411879. IS - 1 JF - Archives of internal medicine SN - 1538-3679 EP - 24 TI - Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest. VL - 169 SP - 15 KW - 2009 KW - cardiac_arrrest KW - corticosteroids KW - epinephrine KW - vasopressin AU - Mentzelopoulos, Spyros AU - Zakynthinos, Spyros AU - Tzoufi, Maria AU - Katsios, Nikos AU - Papastylianou, Androula AU - Gkisioti, Sotiria AU - Stathopoulos, Anastasios AU - Kollintza, Androniki AU - Stamataki, Elissavet AU - Roussos, Charis PY - 2009/01/12/ UR - http://dx.doi.org/10.1001/archinternmed.2008.509 ER -