VAM-IHCA

Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest

Paciente / Población Intervención / Exposición Comparación Desenlace

In 501 adults with in-hospital cardiac arrest, vasopressin plus methylprednisolone increased return of spontaneous circulation compared with placebo.

501

Diseño

Investigator-initiated multicenter, randomized, double-blind, placebo-controlled, parallel-group superiority trial at 10 hospitals in Denmark; 512 adults with in-hospital cardiac arrest receiving at least one dose of epinephrine were randomized between 15 October 2018 and 21 January 2021, and 501 were analyzed (237 intervention, 264 placebo). Vasopressin 20 IU plus methylprednisolone 40 mg was given after the first epinephrine dose, with further vasopressin 20 IU after each subsequent epinephrine dose up to 4 doses, versus matching placebo. Median time from arrest to epinephrine was 5 minutes in both groups; to study drug 8 minutes (intervention) vs 9 minutes (placebo). No loss to follow-up at 90 days.

Desenlace

Primary: return of spontaneous circulation. Secondary: survival and favorable neurologic outcome (Cerebral Performance Category 1 or 2) at 30 days.

ResultadoROSC occurred in 100/237 (42%) with vasopressin plus methylprednisolone vs 86/264 (33%) with placebo (risk ratio 1.30, 95% CI 1.03-1.63; risk difference 9.6%, 95% CI 1.1%-18.0%; P = .03). At 30 days, 23 patients (9.7%) vs 31 (12%) were alive (RR 0.83, 95% CI 0.50-1.37; P = .48), and favorable neurologic outcome was 18 (7.6%) vs 20 (7.6%) (RR 1.00, 95% CI 0.55-1.83; P > .99). Among patients with ROSC, hyperglycemia occurred in 77% vs 73% and hypernatremia in 28% vs 31%.

Andersen LW, Isbye D, Kjærgaard J, et al. Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2021;326(16):1586-1594. 10.1001/jama.2021.16628