Dr. Miller
Clinical question: Does the administration of vasopressin and methylprednisolone during in-hospital cardiac arrest improve the likelihood of return of spontaneous circulation (ROSC)?
Background: Previous trials have suggested improved outcomes when vasopressin and methylprednisolone are administered during in-hospital cardiac arrest.
Study design: Multicenter, randomized, double-blind trial comparing a combination of vasopressin plus methylprednisolone versus placebo.
Setting: Ten hospitals in Denmark enrolling 512 adult patients with in-hospital cardiac arrest.
Synopsis: The primary outcome of ROSC sustained for more than 20 minutes occurred in significantly more patients in the vasopressin plus methylprednisolone group compared to the placebo group. (42% versus 33% respectively; HR 1.3, P=0.03). No difference was observed in secondary outcomes of death, favorable neurologic status, or quality of life at 30 or 90 days.
Bottom line: Among patients with in-hospital cardiac arrest, administration of vasopressin and methylprednisolone increase the likelihood of ROSC. It is uncertain whether this drug combination has an impact on survival, reduced neurologic disability, or quality of life.
Citation: Andersen LW 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. doi: 10.1001/jama.2021.16628.
Dr. Miller is an assistant professor of medicine at the University of Colorado School of Medicine hospital medicine section, Rocky Mountain Regional VA Medical Center, Aurora, Colo.