July - 2013
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Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest: A Randomized Clinical TrialSpyros D. Mentzelopoulos, Sotirios Malachias, Christos Chamos, et al. JAMA, 2013, 310(3):270-279 This page is only available to Crit-IQ subscribers. To view the rest of this review and gain access to our vast array of critical care teaching tools including podcasts, vodcasts, modules, exam preparation tools, teaching aids and much more, login here, or Become a Member to register |
July |
Previous Comments
| VERY interesting paper! Probably should be practice changer - but will take time to percolate to the guidelines. Basically, the intervention lead to a greater number of survivors to ROSC. This translated to a greater number of quality survivors. High quality survival overall for in-hospital arrest was still poor in both groups, but the 5% seen in the control group is consistent with previous literature. A much larger proportion of asystolic and PEA arrests than are commonly seen in community arrest, (84%), with an unequal split of PEA and Asystole between groups. Would have been interesting to see a break-down of arrest type for the survivors. | |
| matbailey-22 Jul, 2013 06:18:27 PM | |
| Not so sure. There wasn't much interest when the same people published Lazarine recoveries from in-hospital cardiac arrest in 2009. Also, 13% "Slight to Moderate" disability was quoted in 1985 post hypoxic-ischaemic non traumatic coma (Levy, D.E., Caronna, J.J., Singer, B.H., et al. Predicting outcome from hypoxic-ischemic coma. JAMA Vol 253 no. 10, March 8.1985). This is unlikely to be a practice changer given that we've seen this sort of data before; eg abdominal counterpulsation during cardiac arrest: Jeffrey B. Sack, MD; Michael B. Kesselbrenner, MD; David Bregman, MD JAMA. 1992;267(3):379-385. doi:10.1001/jama.1992.03480030057037. Anyone doing counterpulsation? Or intracoronary levosimendan or zoniporide? Worse, see Roger Lewis's JAMA editorial [2006 22(295): p2661] commenting on the discordant results of two trials published on a load distributing band - which had previously had a randomised controlled pilot with good results, yet a second trial run by different people convincingly showed harm. Appropriate therapeutic inertia should be applied to this, and a further study in a different healthcare setting would be much more convincing. As it is, my prior probability for believing this is pretty low. | |
| LTC-29 Jul, 2013 03:43:40 PM | |
Comment
This prospective double blinded RCT compares vasopressin/corticosteroids/epinephrine (VSE) to standard care (adrenaline) on survival and neurological outcomes in patients with in-hospital cardiac arrest.
In 3 Greek tertiary care centers, 268 patients with...