Vasopressin, Epinephrine, and Corticosteroids for In-Hospital Cardiac Arrest

Mentzelopoulos, Spyros D.; Zakynthinos, Spyros; Tzoufi, Maria J.; Katsios, Nikos; Papastylianou, Androula; Gkisioti, Sotiria; Stathopoulos, Anastasios; Kollintza, Androniki; Stamataki, E.; Roussos, Charis

doi:10.1001/archinternmed.2008.509

Cited by 211 publications

(318 citation statements)

References 28 publications

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“…Analyses from three trials [12][13][14] showed RR of shock reversal of 1.42 (95% CI 0.39-5.24), of survival to hospital discharge of 1.96 (95% CI 0.68-5.64), and of good neurological recovery at hospital discharge of 1.45 (95% CI 0.41-5.13) in favor of corticosteroids. Another trial of 268 adults with in-hospital cardiac arrest found an OR of return to spontaneous circulation of 2.98 (95% CI 1.39-6.40) and of survival to hospital discharge with good neurological outcome of 3.28 (95% CI 1.17-9.20) in favor of methylprednisolone (given during resuscitation), and a OR of survival to hospital discharge with good neurological outcome of 3.74 (95% CI 1.20-11.62) in favor of hydrocortisone (given for post-resuscitation shock) [15].…”

Section: Rationalementioning

confidence: 99%

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

2017

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Section: Rationalementioning

confidence: 99%

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

2017

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“…The prespecified primary outcome was favorable neurocognitive outcome at hospital discharge, defined as cerebral performance category (CPC) of 1 or 2 (26)(27)(28)(29). CPC scale ranges from 1 to 5, with 1 indicating normal function or minor neurocognitive deficit, 2 moderate disability, 3 severe disability, 4 coma/vegetative state, and 5 death or brain death.…”

Section: Primary Outcomementioning

confidence: 99%

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

Beitler

Ghafouri

Jinadasa

et al. 2017

Am J Respir Crit Care Med

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Rationale: Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) is often poor, even when initial resuscitation succeeds. Lower tidal volumes (VTs) attenuate extrapulmonary organ injury in other disease states and are neuroprotective in preclinical models of critical illness.Objective: To evaluate the association between VT and neurocognitive outcome after OHCA.Methods: We performed a propensity-adjusted analysis of a twocenter retrospective cohort of patients experiencing OHCA who received mechanical ventilation for at least the first 48 hours of hospitalization. VT was calculated as the time-weighted average over the first 48 hours, in milliliters per kilogram of predicted body weight (PBW). The primary endpoint was favorable neurocognitive outcome (cerebral performance category of 1 or 2) at discharge.Measurements and Main Results: Of 256 included patients, 38% received time-weighted average VT greater than 8 ml/kg PBW during the first 48 hours. Lower VT was independently associated with favorable neurocognitive outcome in propensityadjusted analysis (odds ratio, 1.61; 95% confidence interval [CI], 1.13-2.28 per 1-ml/kg PBW decrease in VT; P = 0.008). This finding was robust to several sensitivity analyses. Lower VT also was associated with more ventilator-free days (b = 1.78; 95% CI, 0.39-3.16 per 1-ml/kg PBW decrease; P = 0.012) and shockfree days (b = 1.31; 95% CI, 0.10-2.51; P = 0.034). VT was not associated with hypercapnia (P = 1.00). Although the propensity score incorporated several biologically relevant covariates, only height, weight, and admitting hospital were independent predictors of VT less than or equal to 8 ml/kg PBW.Conclusions: Lower VT after OHCA is independently associated with favorable neurocognitive outcome, more ventilator-free days, and more shock-free days. These findings suggest a role for low-VT ventilation after cardiac arrest.

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“…In a recent single center placebo-controlled trial [31], 100 consecutive patients with in-hospital cardiac arrest were randomized to receive either 1 mg epinephrine or epinephrine plus 20 IU vasopressin per resuscitation cycle for the fi rst fi ve cycles, followed by additional epinephrine if needed. Based on the results of previous observational studies which documented low cortisol levels in patients resuscitated from cardiac arrest, the intervention group received 40 mg methylprednisolone sodium succinate during the fi rst resuscitation cycle.…”

Section: Epinephrine Versus Vasopressin: Results Of Clinical Trialsmentioning

confidence: 99%

Is There Still a Place for Vasopressors in the Treatment of Cardiac Arrest?

Sandroni¹,

Cavallaro²,

Antonelli³

2012

Annual Update in Intensive Care and Emergency Medicine 2012

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Vasopressin, Epinephrine, and Corticosteroids for In-Hospital Cardiac Arrest

Abstract: clinicaltrials.gov Identifier: NCT00411879.

Cited by 211 publications

References 28 publications

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

Is There Still a Place for Vasopressors in the Treatment of Cardiac Arrest?

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