Combined therapy during CPR improves neurological outcomes

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1. Vasopressin-steroids-epinephrine combination patients were more likely to have return to spontaneous circulation and survive to hospital discharge with good neurologic function. 

2. Vasopressin-steroid-epinephrine combination patients with postresuscitation shock, given hydrocortisone, were more likely to survive to hospital discharge with good neurologic function. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Given that the prevalence of neurologic deficits among cardiac arrest survivors can range up to 50%, the question of neurologically favorable survival in cardiac arrest patients is an important one. Previous studies have demonstrated improved survival after the use of combination therapy, vasopressin-epinephrine during CPR and corticosteroid supplementation postarrest; however, this is the first study demonstrating improved neurologically favorable survival in patients with combination therapy. It is also the first to show that the use of hydrocortisone in post-resuscitation shock lead to better survival and neurological outcomes. While this study has demonstrated that the use of combination therapy leads to more favorable neurological outcomes, additional follow up of participants is needed to determine long-term neurological status. Additionally, further randomized controlled trial analyses of the mechanism by which the treatment of postresuscitation shock with corticosteroids produces more favorable neurological outcomes would be clinically relevant as well.

Click to read the study published today in JAMA

Relevant Reading: Vasopressin, Epinephrine, and Corticosteroids for In-Hospital Cardiac Arrest

In-Depth [randomized, double-blind, placebo-controlled trial]: This study included 268 patients with cardiac arrest from September 2008 to October 2010. Patients were randomly assigned to the VSE (vasopressin-steroids-epinephrine) group or to the control group, who received epinephrine and saline placebo. VSE patients with post-resuscitation shock received hydrocortisone. VSE group patients were more likely to survive to discharge with favorable neurologic recovery, meaning a CPC (Glasgow-Pittsburgh Cerebral Performance Category) score of 1 or 2 (OR, 3.28; 95% CI, 1.17-9.20; P = .02). VSE patients also had significantly better mean arterial, systolic, and diastolic pressures during CPR and approximately 20 minutes following return of spontaneous circulation (ROSC) (P= < .001 for all variables). Additionally, VSE patients required fewer numbers of CPR cycles (P= .001) and less epinephrine use (P= .002). Furthermore, VSE patients with post-resuscitation shock were more likely to survive to discharge (OR, 3.74; 95% CI, 1.20-11.62; P = .02) with favorable neurologic recovery.

By Elizabeth Park and Brittany Hasty

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