Daniel D. Dressler, MD, MSc, FHM 

This combination improved neurologically favorable survival.

Aside from aggressive chest compressions and early defibrillation, robust data are lacking on interventions to improve cardiac arrest outcomes. A small study in 2009 suggested improved surrogate outcomes with use of a vasopressin-steroids-epinephrine (VSE) combination for in-hospital cardiac arrest. These data prompted researchers in Greece to perform a randomized trial involving 300 in-hospital cardiac arrest patients who required at least one dose of epinephrine.

Patients received either VSE (20 units vasopressin and 1 mg epinephrine per 3-minute cycle for up to 5 cycles plus 40 mg methylprednisolone with the first dose of epinephrine) or placebo (saline) plus the standard 1 mg epinephrine dose during each 3-minute cycle. Postresuscitation shock was treated with stress-dose hydrocortisone in the VSE group versus saline in the control group. Patients who received VSE were significantly more likely to be alive at hospital discharge with neurologically favorable outcomes than controls (14% vs. 5%; number needed to treat [NNT], 11). Among 149 patients with return of spontaneous circulation who then developed postresuscitation shock, those in the VSE group were also significantly more likely than controls to be alive at hospital discharge with neurologically favorable outcomes (21% vs. 8%; NNT, 8).

Citation(s):

Mentzelopoulos SD et al. Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest: A randomized clinical trial. JAMA 2013 Jul 17; 310:270.