VSE
Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest
Doente / População Intervenção / Exposição Comparação Desfecho
In 268 adults with in-hospital cardiac arrest, vasopressin plus steroids added to epinephrine improved neurologically intact survival to discharge versus epinephrine alone.
N
268
Desenho
Randomized, double-blind, placebo-controlled, parallel-group trial in 3 Greek tertiary care centers (Sept 2008–Oct 2010); 268 analyzed of 300 randomized (calculated sample size 244; assumed 15% vs 4% event rates, alpha 0.05, power 0.80); VSE n=130 received vasopressin 20 IU plus epinephrine 1 mg per CPR cycle for the first 5 cycles and methylprednisolone 40 mg during the first cycle, with stress-dose hydrocortisone 300 mg/d for postresuscitation shock; control n=138 received epinephrine plus saline placebo; mean age 63.2 vs 62.8 years; 16.2% vs 15.2% of arrests occurred in the emergency department; follow-up complete in all resuscitated patients.
Desfecho
Co-primary: return of spontaneous circulation for 20 minutes or longer, and survival to hospital discharge with a Cerebral Performance Category score of 1 or 2.
ResultadoROSC ≥20 min 109/130 (83.9%) with VSE vs 91/138 (65.9%) with epinephrine alone (OR 2.98; 95% CI 1.39–6.40; P=.005); survival to discharge with CPC 1–2 18/130 (13.9%) vs 7/138 (5.1%) (OR 3.28; 95% CI 1.17–9.20; P=.02), an absolute difference of 8.8 percentage points (NNT ~11). Among patients with postresuscitation shock, 16/76 (21.1%) vs 6/73 (8.2%) (OR 3.74; 95% CI 1.20–11.62; P=.02), with better hemodynamics, higher central venous oxygen saturation and less organ dysfunction; adverse event rates were similar.
Mentzelopoulos SD, Malachias S, Chamos C, et al. Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest: a randomized clinical trial. JAMA. 2013;310(3):270-279. 10.1001/jama.2013.7832