Improved neurologic outcomes after cardiac arrest with combined administration of vasopressin, steroids, and epinephrine compared to epinephrine alone

Abstract

Clinical questionIs a vasopressin, steroid, and epinephrine (VSE) protocol for in-hospital cardiac arrest resuscitation associated with better survival to hospital discharge with favourable neurologic outcome compared to epinephrine alone?Article chosenMentzelopoulos S, Malachias S, Konstantopoulos D, et al. Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest: a randomized clinical trial. JAMA 2013;310:270-9.ObjectiveTo determine if a VSE protocol during cardiopulmonary resuscitation with hydrocortisone administration in patients with postresuscitative shock at 4 hours after return of spontaneous circulation would improve survival to hospital discharge with favourable neurologic outcome.

Nuevas recomendaciones sobre el uso de corticoides en el paciente crítico

“…-En pacientes que han sufrido parada cardíaca recomiendan, con un bajo nivel de evidencia, el uso de corticoides (sin especificar tipo ni dosis) dado que parece que aumenta la supervivencia y reduce las secuelas neurológicas. Los estudios 13,14 que demuestran estos beneficios tienen ciertas restricciones debido a que la resucitación cardiopulmonar no es homogénea, el tipo y dosis de corticoide difiere, al igual que los cuidados tras la parada cardiaca. No obstante, fisiológicamente parece lógico que en una situación de bajo gasto con hipoperfusión hacia la corteza suprarrenal se reduzca la producción de corticoides endógenos y que su aporte externo ayude a mantener un correcto tono vascular y mejore además la acción de drogas vasoactivas.…”

Polímeros Empregados Em Período De Pandemia Sars-Cov-2 a Importância Dos Polímeros Durante a Pandemia De Covid-19

“…Os comprometimentos desse evento podem resultar em danos a diferentes domínios do funcionamento cognitivo em sobreviventes a longo prazo, a depender do local do edema cerebral provocado pela PCR, com déficits subsequentes, que variam de leve a grave, podendo resultar até em uma incapacidade neurológica grave, que atinge em torno de 20 % a 50 % dos sobreviventes de PCR (STEINBUSCH et al, 2017;STAMENOVA et al, 2018;BOTNARU et al, 2015;CHOI et al, 2013).…”

“…Nesse contexto, apesar de muitos estudos apontarem uma recuperação significativa dos déficits cognitivos nos primeiros três meses após a ressuscitação, os danos neurológicos persistentes, presentes até mesmo nos pacientes com resultado neurológico relativamente promissores, podem afetar negativamente a qualidade de vida, a participação e a autonomia dos sobreviventes (STEINBUSCH et al, 2017;BOTNARU et al, 2015;NEKOUI et al, 2016;ORBO et al, 2018).…”

Development a clinical prediction model of the neurological outcome for patients with coma and survived 24 hours after cardiopulmonary resuscitation

“…3 Among the patients with successful CPR, the rate of favorable neurological outcome was only 2.7% to 13.9%. [4][5][6] Most of the patients with unfavorable neurological outcome eventually died or were in a vegetative state. 7,8 At present, related studies had shown that electroencephalogram, short-delay somatosensory evoked potential (SSEEP), neuron-specific enolase (NSE), S-100B, microRNAs (miRNAs), near-infrared spectroscopy (NIRS), and so forth may be used as a predictor of neurological function for patients with successful CPR.…”

“…The neurological outcome is the core indicator of the prognosis of cardiac arrest 3 . Among the patients with successful CPR, the rate of favorable neurological outcome was only 2.7% to 13.9% 4‐6 . Most of the patients with unfavorable neurological outcome eventually died or were in a vegetative state 7,8 .…”