Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest

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dc.contributor.authorMentzelopoulos, S. D.en
dc.contributor.authorZakynthinos, S. G.en
dc.contributor.authorTzoufi, M.en
dc.contributor.authorKatsios, N.en
dc.contributor.authorPapastylianou, A.en
dc.contributor.authorGkisioti, S.en
dc.contributor.authorStathopoulos, A.en
dc.contributor.authorKollintza, A.en
dc.contributor.authorStamataki, E.en
dc.contributor.authorRoussos, C.en
dc.date.accessioned2015-11-24T18:50:58Z
dc.date.available2015-11-24T18:50:58Z
dc.identifier.issn1538-3679-
dc.identifier.urihttps://olympias.lib.uoi.gr/jspui/handle/123456789/18188
dc.rightsDefault Licence-
dc.subjectAdulten
dc.subjectAgeden
dc.subjectAged, 80 and overen
dc.subjectCardiopulmonary Resuscitation/methodsen
dc.subjectCause of Deathen
dc.subjectConfidence Intervalsen
dc.subjectCross-Over Studiesen
dc.subjectDose-Response Relationship, Drugen
dc.subjectDouble-Blind Methoden
dc.subjectDrug Therapy, Combinationen
dc.subjectEmergency Service, Hospitalen
dc.subjectEpinephrine/*administration & dosageen
dc.subjectFemaleen
dc.subjectFollow-Up Studiesen
dc.subjectHeart Arrest/*drug therapy/*mortality/therapyen
dc.subjectHospital Mortality/*trendsen
dc.subjectHospitalizationen
dc.subjectHumansen
dc.subjectInfusions, Intravenousen
dc.subjectIntensive Care Unitsen
dc.subjectKaplan-Meier Estimateen
dc.subjectMaleen
dc.subjectMethylprednisolone/*administration & dosageen
dc.subjectMiddle Ageden
dc.subjectProbabilityen
dc.subjectProportional Hazards Modelsen
dc.subjectProspective Studiesen
dc.subjectReference Valuesen
dc.subjectRisk Assessmenten
dc.subjectSurvival Rateen
dc.subjectTreatment Outcomeen
dc.subjectVasopressins/*administration & dosageen
dc.titleVasopressin, epinephrine, and corticosteroids for in-hospital cardiac arresten
heal.abstractBACKGROUND: Animal data on cardiac arrest showed improved long-term survival with combined vasopressin-epinephrine. In cardiac arrest, cortisol levels are relatively low during and after cardiopulmonary resuscitation. We hypothesized that combined vasopressin-epinephrine and corticosteroid supplementation during and after resuscitation may improve survival in refractory in-hospital cardiac arrest. METHODS: We conducted a single-center, prospective, randomized, double-blind, placebo-controlled, parallel-group trial. We enrolled 100 consecutive patients with cardiac arrest requiring epinephrine according to current resuscitation guidelines. Patients received either vasopressin (20 IU per cardiopulmonary resuscitation cycle) plus epinephrine (1 mg per resuscitation cycle) (study group; n = 48) or isotonic sodium chloride solution placebo plus epinephrine (1 mg per resuscitation cycle) (control group; n = 52) for the first 5 resuscitation cycles after randomization, followed by additional epinephrine if needed. On the first resuscitation cycle, study group patients received methylprednisolone sodium succinate (40 mg) and controls received saline placebo. Postresuscitation shock was treated with stress-dose hydrocortisone sodium succinate (300 mg daily for 7 days maximum, with gradual taper) (27 patients in the study group) or saline placebo (15 patients in the control group). Primary end points were return of spontaneous circulation for 15 minutes or longer and survival to hospital discharge. RESULTS: Study group patients vs controls had more frequent return of spontaneous circulation (39 of 48 patients [81%] vs 27 of 52 [52%]; P = .003) and improved survival to hospital discharge (9 [19%] vs 2 [4%]; P = .02). Study group patients with postresuscitation shock vs corresponding controls had improved survival to hospital discharge (8 of 27 patients [30%] vs 0 of 15 [0%]; P = .02), improved hemodynamics and central venous oxygen saturation, and more organ failure-free days. Adverse events were similar in the 2 groups. CONCLUSION: In this single-center trial, combined vasopressin-epinephrine and methylprednisolone during resuscitation and stress-dose hydrocortisone in postresuscitation shock improved survival in refractory in-hospital cardiac arrest. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00411879.en
heal.accesscampus-
heal.fullTextAvailabilityTRUE-
heal.identifier.primary10.1001/archinternmed.2008.509-
heal.identifier.secondaryhttp://www.ncbi.nlm.nih.gov/pubmed/19139319-
heal.identifier.secondaryhttp://archinte.ama-assn.org/cgi/reprint/169/1/15.pdf-
heal.journalNameArch Intern Meden
heal.journalTypepeer-reviewed-
heal.languageen-
heal.publicationDate2009-
heal.recordProviderΠανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικήςel
heal.typejournalArticle-
heal.type.elΆρθρο Περιοδικούel
heal.type.enJournal articleen

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