Animal studies have demonstrated improved cardiac arrest survival rates with combined use of vasopressin and epinephrine. Lower cortisol levels are known to be associated with cardiac arrest during and after cardiopulmonary resuscitation (CPR). Therefore, to determine whether vasopressin and epinephrine combined with a corticosteroid might be beneficial to the body's responses to cardiac arrest, Mentzelopoulos and colleagues decided to test the effects of these treatments on survival in patients with in-hospital refractory cardiac arrest.

In this single-center, prospective, double-blind study, 100 consecutive patients with in- hospital refractory cardiac arrest were randomly assigned to receive vasopressin and epinephrine (n = 48; study group) or saline placebo and epinephrine (n = 52; control group) during the first five CPR cycles. The study group also received methylprednisolone during the first CPR cycle, whereas the control group received saline placebo. Stress-dose hydrocortisone treatment or saline placebo was also given to 27 patients in the study group and 15 patients in the control group, respectively, to treat postresuscitation shock.

Results showed that patients in the study group achieved spontaneous circulation more often than those in the control group (81% versus 52%) and more survived to hospital discharge (19% versus 4%). Likewise, among patients with postresuscitation shock, more study group patients (30%) survived to hospital discharge compared with control patients (0%), and exhibited better hemodynamic values and fewer days of organ failure. In fact, the authors estimated that combined use of vasopressin, epinephrine, and corticosteroids in patients with in-hospital refractory cardiac arrest may improve their long-term survival rate by 4.5-fold.

JC