Vasopressin and methylprednisolone improve outcomes during in hospital cardiac arrest: JAMA

Previous trials have suggested that vasopressin and methylprednisolone administered during in-hospital cardiac arrest might improve outcomes.

A group of researchers from Denmark conducted a study to determine whether the combination of vasopressin and methylprednisolone administered during in-hospital cardiac arrest improves the return of spontaneous circulation.

Multicenter, randomized, double-blind, placebo-controlled trial conducted at 10 hospitals in Denmark. A total of 512 adult patients with in-hospital cardiac arrest were included between October 15, 2018, and January 21, 2021. The last 90-day follow-up was on April 21, 2021.

Patients were randomized to receive a combination of vasopressin and methylprednisolone (n = 245) or a placebo (n = 267). The first dose of vasopressin (20 IU) and methylprednisolone (40 mg), or corresponding placebo, was administered after the first dose of epinephrine. Additional doses of vasopressin or corresponding placebo were administered after each additional dose of epinephrine for a maximum of 4 doses.

The results of the study are as follows:

· Among 512 patients who were randomized, 501 met all inclusion and no exclusion criteria and were included in the.

· One hundred of 237 patients (42%) in the vasopressin and methylprednisolone group and 86 of 264 patients (33%) in the placebo group achieved return of spontaneous circulation.

· At 30 days, 23 patients (9.7%) in the intervention group and 31 patients (12%) in the placebo group were alive.

· A favourable neurologic outcome was observed in 18 patients (7.6%) in the intervention group and 20 patients (7.6%) in the placebo group at 30 days (risk ratio, 1.00; risk difference, 0.0%.

· In patients with return of spontaneous circulation, hyperglycemia occurred in 77 (77%) in the intervention group and 63 (73%) in the placebo group.

· Hypernatremia occurred in 28 (28%) and 27 (31%), in the intervention and placebo groups, respectively.

Thus, the researchers concluded that among patients with in-hospital cardiac arrest, administration of vasopressin and methylprednisolone, compared with placebo, significantly increased the likelihood of return of spontaneous circulation. However, there is uncertainty whether this treatment results in benefit or harm for long-term survival.

Reference:

Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients with In-Hospital Cardiac Arrest: A Randomized Clinical Trial by Andersen L et. al published in the JAMA.

doi:10.1001/jama.2021.16628