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July - 2013

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Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest: A Randomized Clinical Trial

Spyros D. Mentzelopoulos, Sotirios Malachias, Christos Chamos, et al. JAMA, 2013, 310(3):270-279


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...


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