Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest

Abstract

clinicaltrials.gov Identifier: NCT00729794.

Part 7: Adult Advanced Cardiovascular Life Support

“…138,139 2015 Evidence Summary: OHCA In OHCA, steroids have been evaluated in 1 RCT 140 and 1 observational study. 141 In these studies, steroids were not bundled as they were in the IHCA but studied as a sole treatment.…”

“…In IHCA, the combination of intra-arrest vasopressin, epinephrine, and methylprednisolone and post-arrest hydrocortisone as described by Mentzelopoulos et al 139 may be considered; however, further studies are needed before recommending the routine use of this therapeutic strategy (Class IIb, LOE C-LD).…”

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

“…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]. See Appendix 2 in Supplementary material for evidence profile.…”

Medication Errors in Cardiopulmonary Arrest and Code-Related Situations

“…For example, because of the favorable results of a recent study, 28 some providers may ask for methylprednisolone during resuscitation efforts. New medications bring additional challenges to reducing medication errors; not only must new medications be added to code carts throughout the entire institution but also all personnel must become familiar with the dosing and delivery systems of the new medications, which with methylprednisolone may include the Act-O-Vial system.…”