Vasopressin and Methylprednisolone vs Placebo and Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest

Jiménez-Cuja, Richard; Salazar-Orihuela, Victor; Llanco, Luis

doi:10.1001/jama.2021.23048

Cited by 1 publication

(3 citation statements)

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“…Therefore, the VAM-IHCA Study provided an insufficient dose of vasopressin in the intervention group. 31 A difference between our study and those two recent studies 29 30 by Granfeldt et al and Saghafi et al is that we evaluated the overall impact of vasopressin in cardiac arrest. There is no single optimal method suitable for all patients.…”

Section: Discussionmentioning

confidence: 75%

“…Therefore, the VAM-IHCA Study provided an insufficient dose of vasopressin in the intervention group. 31 …”

Section: Discussionmentioning

confidence: 99%

“…It is worth noting that the average dose of vasopressin used in the VAM-IHCA Study was 47 IU, while the average dose was 70.3–73.3 IU in the studies by Mentzelopoulos et al in 2013 and 2009. Therefore, the VAM-IHCA Study provided an insufficient dose of vasopressin in the intervention group 31…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic effects of vasopressin on cardiac arrest: a systematic review and meta-analysis

et al. 2023

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ObjectiveTo demonstrate the therapeutic effect of vasopressin as an alternative treatment for cardiac arrest.DesignSystematic review and meta-analysis.MethodsPubMed, EMBASE, the Cochrane Library and Web of Science were searched for randomised controlled trials. The intervention included administration of vasopressin alone or vasopressin combined with epinephrine or vasopressin, steroids and epinephrine (VSE) versus epinephrine combined with placebo as control group. The primary outcome was the return of spontaneous circulation (ROSC). The secondary outcomes included mid-term survival and mid-term good neurological outcome. We conducted subgroup analyses of the primary outcome based on different settings, different study drug strategies and different types of initial rhythm.ResultsTwelve studies (n=6718) were included, of which eight trials (n=5638) reported the data on patients with out-of-hospital cardiac arrest and four trials (n=1080) on patients with in-hospital cardiac arrest (IHCA). There were no significant differences between intravenous vasopressin and placebo in the outcomes of ROSC (relative risk (RR): 1.11; 95% CI: 0.99 to 1.26), mid-term survival (RR: 1.23; 95% CI: 0.90 to 1.66) and mid-term good neurological outcome (RR: 1.20; 95% CI: 0.77 to 1.87). However, in the subgroup analysis, intravenous vasopressin as part of VSE can significantly improve the rate of ROSC (RR: 1.32; 95% CI: 1.18 to 1.47) but not the rate of mid-term survival (RR: 2.15; 95% CI: 0.75 to 6.16) and mid-term good neurological outcome (RR: 1.80; 95% CI: 0.81 to 4.01) for patients with IHCA.ConclusionsOur study failed to demonstrate increased benefit from vasopressin with or without epinephrine compared with the standard of care. However, vasopressin as a part of VSE is associated with the improvement of ROSC in patients with IHCA, and the benefit on mid‐term survival or mid-term good neurological outcome is uncertain. Larger trials should be conducted in the future to address the effect of vasopressin only, vasopressin plus epinephrine or VSE on cardiac arrest.PROSPERO registration numberCRD42021293347.

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Section: Discussionmentioning

confidence: 75%

“…Therefore, the VAM-IHCA Study provided an insufficient dose of vasopressin in the intervention group. 31 …”

Section: Discussionmentioning

confidence: 99%

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Therapeutic effects of vasopressin on cardiac arrest: a systematic review and meta-analysis

et al. 2023

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Vasopressin and Methylprednisolone vs Placebo and Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest

Cited by 1 publication

References 4 publications

Therapeutic effects of vasopressin on cardiac arrest: a systematic review and meta-analysis

Therapeutic effects of vasopressin on cardiac arrest: a systematic review and meta-analysis

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