1. Singh Joy, Subhashni D.


According to this study:


* Vasopressin-epinephrine with methylprednisolone during resuscitation and hydrocortisone for postresuscitation shock improved survival and neurologic outcomes.



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A recent study at three hospitals in Greece sought to determine whether a combination of vasopressors and epinephrine plus corticosteroids (during and after resuscitation) improved survival and neurologic outcomes in patients with in-hospital vasopressor-requiring cardiac arrest. In the first CPR cycle, patients in the vasopressin-steroids-epinephrine (VSE) group received 40 mg of methylprednisolone sodium succinate; patients in the control group received a saline placebo. During the first five CPR cycles, all patients received epinephrine. VSE patients received 20 to 100 IU of vasopressin, depending on the duration of CPR; patients in the placebo group received saline. In addition, patients in the VSE group who had postresuscitation shock four hours after resuscitation received a stress dose of hydrocortisone, 300 mg per day, for up to seven days. Those exhibiting symptoms of myocardial infarction also received hydrocortisone for up to three days.


A total of 130 patients in the VSE group and 138 in the control group were included in the analysis. Compared with controls, patients in the VSE group had a higher probability of experiencing a return of spontaneous circulation for 20 minutes or longer, received less epinephrine during advanced life support, and needed life support for a shorter time. In the VSE group, 76 of 86 surviving patients had postresuscitation shock four hours after resuscitation, compared with 73 of 76 in the control group.


Patients in the VSE group were more likely to survive and to be discharged with a favorable neurologic outcome than patients in the control group; this was also true in the subset of patients with postresuscitation shock. Postarrest morbidity and complications were similar in the two groups, as were mean ventilator-free days and ICU, cardiac unit, and hospital stays.




Mentzelopoulos SD, et al. JAMA. 2013;310(3):270-9