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The efficacy of epinephrine during out-of hospital cardiac arrest has been questioned in recent years, especially with respect to neurologic outcomes (ref#1).
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A recent study demonstrated both a survival and neurologic benefit to using epinephrine during in-hospital cardiac arrest when used in combination with vasopressin and methylprednisolone.
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Researchers in Greece randomized 268 consecutive patients with in-hospital cardiac arrest to receive either epinephrine + placebo (control group; n=138) or vasopressin, epinephrine, and methylprednisolone (intervention arm; n=130)
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Vasopressin (20 IU) was given with epinephrine each CPR cycle for the first 5 cycles; Epinephrine was given alone thereafter (if necessary)
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Methylprednisolone (40 mg) was only given during the first CPR cycle.
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If there was return of spontaneous circulation (ROSC) but the patient was in shock, 300 mg of methylprednisolone was given daily for up to 7 days.
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Primary study end-points were ROSC for 20 minutes or more and survival to hospital discharge while monitoring for neurological outcome
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The results were that patients in the intervention group had a statistically significant:
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probability of ROSC for > 20 minutes (84% vs. 66%)
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survival with good neurological outcomes (14% vs. 5%)
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survival if shock was present post-ROSC (21% vs. 8%)
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better hemodynamic parameters, less organ dysfunction, and better central venous saturation levels
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Bottom-line: This study may present a promising new therapy for in-hospital cardiac arrest and should be strongly considered.
References
- Jacobs, I. et. al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomized double-blind placebo-controlled trial. Resuscitation 2011 Sep;82(9):1138-43
- Spyros Mentzelopoulos et al. Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac ArrestA Randomized Clinical Trial. JAMA 2013;310(3):270-279.
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