This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Critical Care/ Intensive Care Medicine  • Adult Critical Care  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Spyros D. Mentzelopoulos, MD, PhD; Spyros G. Zakynthinos, MD, PhD; Maria Tzoufi, MD, PhD; Nikos Katsios, MD; Androula Papastylianou, MD; Sotiria Gkisioti, MD; Anastasios Stathopoulos, MD; Androniki Kollintza, PhD; Elissavet Stamataki, MD, PhD; Charis Roussos, MD, PhD

Arch Intern Med. 2009;169(1):15-24.

Background  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

Author Affiliations: First Department of Intensive Care Medicine, University of Athens Medical School (Drs Mentzelopoulos, Zakynthinos, Tzoufi, Kollintza, and Roussos); and Department of Anesthesiology, Evaggelismos General Hospital (Drs Katsios, Papastylianou, Gkisioti, Stathopoulos, and Stamataki), Athens, Greece.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

In This Issue of Archives of Internal Medicine
Arch Intern Med. 2009;169(1):8.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Multidrug Cocktail for In-Hospital Cardiac Arrest
JWatch Emergency Med. 2009;2009:1-1.
FULL TEXT