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Combination therapy during CPR improved survival, neurological status after cardiac arrest
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Patients with cardiac arrest given a combination of vasopressin, steroids and epinephrine during in-hospital cardiopulmonary resuscitation experienced improved survival to discharge and favorable neurological status compared with patients given epinephrine alone, according to new study results.
In a previous study, patients given vasopressin and epinephrine during CPR and corticosteroids during and after CPR had improved survival rates compared with patients given epinephrine alone. However, no previous study had assessed the efficacy of the vasopressin-epinephrine-steroids combination on neurologically favorable outcomes.
The randomized, double blind, placebo-controlled, parallel-group VSE-2 study was performed from September 2008 to October 2010 at three sites in Greece. The study included 268 patients with cardiac arrest requiring epinephrine as per resuscitation guidelines.
One group (n=130) received arginine vasopressin (20 IU/CPR cycle) plus epinephrine (1 mg/CPR cycle) for the first five CPR cycles after randomization, and then were administered additional epinephrine if needed. During the first CPR cycle after randomization, this group received methylprednisolone (40 mg). The other group (n=138) followed the same regimen, but was administered saline placebo instead of vasopressin and methylprednisolone.
The primary outcomes of interest included return of spontaneous circulation and survival to hospital discharge with a Cerebral Performance Category score of 1 or 2, which indicates good or moderate cerebral performance.
Patients in the vasopressin-epinephrine-steroids group were more likely to experience return of spontaneous circulation of 20 minutes or longer compared with the epinephrine-placebo group (109/130 [83.9%] vs. 91/138 [65.9%]; OR=2.98; 95% CI, 1.39-6.4). The combination therapy group also had a better rate of survival to hospital discharge with a Cerebral Performance Category score of 1 or 2 (18/130 [13.9%] vs. 7/138 [5.1%]; OR=3.28; 95% CI, 1.17-9.2). Further, patients in the combination therapy group were more likely to be alive at hospital discharge with favorable neurological recovery compared with the epinephrine-placebos group (16/76 [21.1%] vs. 6/73 [8.2%]; OR=3.74; 95% CI, 1.2-11.62).
Vasopressin-epinephrine-steroids also were associated with improved hemodynamics, improved central venous oxygen saturation and less organ dysfunction than the epinephrine-placebo. Adverse event rates were similar in the two groups.
Disclosure: The study was funded in part by the Greek Society of Intensive Care and the Greek Ministry of Education. The researchers report no relevant financial disclosures.
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