Category: Critical Care
Posted: 9/30/2013 by Haney Mallemat, MD
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The efficacy of epinephrine during out-of hospital cardiac arrest has been questioned in recent years, especially with respect to neurologic outcomes (ref#1).
A recent study demonstrated both a survival and neurologic benefit to using epinephrine during in-hospital cardiac arrest when used in combination with vasopressin and methylprednisolone.
Researchers in Greece randomized 268 consecutive patients with in-hospital cardiac arrest to receive either epinephrine + placebo (control group; n=138) or vasopressin, epinephrine, and methylprednisolone (intervention arm; n=130)
Vasopressin (20 IU) was given with epinephrine each CPR cycle for the first 5 cycles; Epinephrine was given alone thereafter (if necessary)
Methylprednisolone (40 mg) was only given during the first CPR cycle.
If there was return of spontaneous circulation (ROSC) but the patient was in shock, 300 mg of methylprednisolone was given daily for up to 7 days.
Primary study end-points were ROSC for 20 minutes or more and survival to hospital discharge while monitoring for neurological outcome
The results were that patients in the intervention group had a statistically significant:
probability of ROSC for > 20 minutes (84% vs. 66%)
survival with good neurological outcomes (14% vs. 5%)
survival if shock was present post-ROSC (21% vs. 8%)
better hemodynamic parameters, less organ dysfunction, and better central venous saturation levels
Bottom-line: This study may present a promising new therapy for in-hospital cardiac arrest and should be strongly considered.
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