UMEM Educational Pearls

  • 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.