Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest
Journal of the American Medical Association (09/29/21) DOI: 10.1001/jama.2021.16628
Andersen, Lars W.; Isbye, Dan; Kjærgaard, Jesper; et al.
A recent study questioned whether the combination of vasopressin and methylprednisolone can improve the return of spontaneous circulation for patients with in-hospital cardiac arrest. The Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial was conducted at 10 hospitals in Denmark and included 512 adults with in-hospital cardiac arrest between October 2018 and January 2021. Per randomization, 245 patients received a combination of vasopressin and methylprednisolone, while 267 received placebo, with the first dose of vasopressin (20 IU) and methylprednisolone (40 mg), or corresponding placebo, administered after the first dose of epinephrine. Further doses of vasopressin or corresponding placebo were administered following each additional dose of epinephrine, with a maximum of four doses. Of the 501 patients included in the analysis (mean age of 71 years, 64% male), 42% (100 of 237 patients) of the vasopressin and methylprednisolone group achieved the primary outcome — the return of spontaneous circulation — compared with 33% (86 of 264 patients) in the placebo group. Additionally, 9.7% (23 patients) in the combination treatment group were alive at 30 days, compared with 12% (31 patients) in the placebo group. The rate of favorable neurologic outcome was the same, 7.6%, in both groups at 30 days. For patients who achieved the primary outcome, the rate of hyperglycemia was 77% in the intervention group and 73% in the placebo group, while the rates of hypernatremia were 28% and 31%, respectively. The findings demonstrate that compared with placebo, the administration of vasopressin and methylprednisolone significantly raised the likelihood of the return of spontaneous circulation for patients with in-hospital cardiac arrest, although "there is uncertainty whether this treatment results in benefit or harm for long-term survival," the researchers conclude.