Title: Vasopressin, Steroids, and Epi….Oh my! A new cocktail for cardiac arrest?<br/>Author: Haney Mallemat<br/><a href='http://umem.org/profiles/faculty/785/'>[Click to email author]</a><hr/><ul>
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                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;">The efficacy of epinephrine during out-of hospital cardiac arrest has been questioned in recent years, especially with respect to neurologic outcomes (ref#1).</span></span></p>
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                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;">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.</span></span></p>
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                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;">Researchers in Greece randomized 268 consecutive patients with <strong>in-hospital cardiac arrest</strong> to receive either <strong>epinephrine + placebo</strong> (control group; n=138) or <strong>vasopressin, epinephrine, and methylprednisolone</strong> (intervention arm; n=130)</span></span></p>
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                                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;">Vasopressin (20 IU) was given with epinephrine each CPR cycle for the first 5 cycles; Epinephrine was given alone thereafter (if necessary)</span></span></p>
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                                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;">Methylprednisolone (40 mg) was only given during the first CPR cycle.</span></span></p>
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                                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;">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.</span></span></p>
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                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;"><strong>Primary study end-points</strong> were ROSC for 20 minutes or more and survival to hospital discharge while monitoring for neurological outcome</span></span></p>
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                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;">The results were that patients in the intervention group had a statistically significant:</span></span></p>
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                                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;">​</span></span><span style="font-family: verdana, arial, helvetica, sans-serif; font-size: 10px; color: rgb(0, 0, 0);">probability of ROSC for > 20 minutes (84% vs. 66%)</span></p>
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                                        <span style="font-family: verdana, arial, helvetica, sans-serif; font-size: 10px; color: rgb(0, 0, 0);">survival with good neurological outcomes (14% vs. 5%)</span></p>
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                                        <span style="font-family: verdana, arial, helvetica, sans-serif; font-size: 10px; color: rgb(0, 0, 0);">survival if shock was present post-ROSC (21% vs. 8%)</span></p>
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                                        <span style="font-family: verdana, arial, helvetica, sans-serif; font-size: 10px; color: rgb(0, 0, 0);">better hemodynamic parameters, less organ dysfunction, and better central venous saturation levels</span></p>
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                        <span style="color:#000000;"><span style="font-size: 10px; font-family: verdana, arial, helvetica, sans-serif;"><strong>Bottom-line: This study may present a promising new therapy for in-hospital cardiac arrest and should be strongly considered.</strong></span></span></p>
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<fieldset><legend>References</legend>

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                <a href="http://www.resuscitationjournal.com/article/S0300-9572(11)00405-9/abstract">Jacobs, I. et. al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomized double-blind placebo-controlled trial. Resuscitation 2011 Sep;82(9):1138-43</a></li>
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                <a href="http://jama.jamanetwork.com/article.aspx?articleid=1713589">Spyros Mentzelopoulos et al. Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac ArrestA Randomized Clinical Trial. <u>JAMA 2013;310(3):270-279.</u></a></li>
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