Vasopressin and methylprednisolone and hemodynamics after in-hospital cardiac arrest – A post hoc analysis of the VAM-IHCA trial
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Vasopressin and methylprednisolone and hemodynamics after in-hospital cardiac arrest – A post hoc analysis of the VAM-IHCA trial. / Andersen, Lars W.; Holmberg, Mathias J.; Høybye, Maria; Isbye, Dan; Kjærgaard, Jesper; Darling, Søren; Zwisler, Stine T.; Larsen, Jacob M.; Rasmussen, Bodil S.; Iversen, Kasper; Schultz, Martin; Sindberg, Birthe; Fink Valentin, Mikael; Granfeldt, Asger.
I: Resuscitation, Bind 191, 109922, 2023.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Vasopressin and methylprednisolone and hemodynamics after in-hospital cardiac arrest – A post hoc analysis of the VAM-IHCA trial
AU - Andersen, Lars W.
AU - Holmberg, Mathias J.
AU - Høybye, Maria
AU - Isbye, Dan
AU - Kjærgaard, Jesper
AU - Darling, Søren
AU - Zwisler, Stine T.
AU - Larsen, Jacob M.
AU - Rasmussen, Bodil S.
AU - Iversen, Kasper
AU - Schultz, Martin
AU - Sindberg, Birthe
AU - Fink Valentin, Mikael
AU - Granfeldt, Asger
N1 - Publisher Copyright: © 2023 The Author(s)
PY - 2023
Y1 - 2023
N2 - Introduction: The Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial demonstrated a significant improvement in return of spontaneous circulation (ROSC) with no clear effect on long-term outcomes. The objective of the current manuscript was to evaluate the hemodynamic effects of intra-cardiac arrest vasopressin and methylprednisolone during the first 24 hours after ROSC. Methods: The VAM-IHCA trial randomized patients with in-hospital cardiac arrest to a combination of vasopressin and methylprednisolone or placebo during the cardiac arrest. This study is a post hoc analysis focused on the hemodynamic effects of the intervention after ROSC. Post-ROSC data on the administration of glucocorticoids, mean arterial blood pressure, heart rate, blood gases, vasopressor and inotropic therapy, and sedation were collected. Total vasopressor dose between the two groups was calculated based on noradrenaline-equivalent doses for adrenaline, phenylephrine, terlipressin, and vasopressin. Results: The present study included all 186 patients who achieved ROSC in the VAM IHCA-trial of which 100 patients received vasopressin and methylprednisolone and 86 received placebo. The number of patients receiving glucocorticoids during the first 24 hours was 22/86 (26%) in the placebo group and 14/100 (14%) in the methylprednisolone group with no difference in the cumulative hydrocortisone-equivalent dose. There was no significant difference between the groups in the mean cumulative noradrenaline-equivalent dose (vasopressin and methylprednisolone: 603 ug/kg [95CI% 227; 979] vs. placebo: 651 ug/kg [95CI% 296; 1007], mean difference −48 ug/kg [95CI% −140; 42.9], p = 0.30), mean arterial blood pressure, or lactate levels. There was no difference between groups in arterial blood gas values and vital signs. Conclusion: Treatment with vasopressin and methylprednisolone during cardiac arrest caused no difference in mean arterial blood pressure, vasopressor use, or arterial blood gases within the first 24 hours after ROSC when compared to placebo.
AB - Introduction: The Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial demonstrated a significant improvement in return of spontaneous circulation (ROSC) with no clear effect on long-term outcomes. The objective of the current manuscript was to evaluate the hemodynamic effects of intra-cardiac arrest vasopressin and methylprednisolone during the first 24 hours after ROSC. Methods: The VAM-IHCA trial randomized patients with in-hospital cardiac arrest to a combination of vasopressin and methylprednisolone or placebo during the cardiac arrest. This study is a post hoc analysis focused on the hemodynamic effects of the intervention after ROSC. Post-ROSC data on the administration of glucocorticoids, mean arterial blood pressure, heart rate, blood gases, vasopressor and inotropic therapy, and sedation were collected. Total vasopressor dose between the two groups was calculated based on noradrenaline-equivalent doses for adrenaline, phenylephrine, terlipressin, and vasopressin. Results: The present study included all 186 patients who achieved ROSC in the VAM IHCA-trial of which 100 patients received vasopressin and methylprednisolone and 86 received placebo. The number of patients receiving glucocorticoids during the first 24 hours was 22/86 (26%) in the placebo group and 14/100 (14%) in the methylprednisolone group with no difference in the cumulative hydrocortisone-equivalent dose. There was no significant difference between the groups in the mean cumulative noradrenaline-equivalent dose (vasopressin and methylprednisolone: 603 ug/kg [95CI% 227; 979] vs. placebo: 651 ug/kg [95CI% 296; 1007], mean difference −48 ug/kg [95CI% −140; 42.9], p = 0.30), mean arterial blood pressure, or lactate levels. There was no difference between groups in arterial blood gas values and vital signs. Conclusion: Treatment with vasopressin and methylprednisolone during cardiac arrest caused no difference in mean arterial blood pressure, vasopressor use, or arterial blood gases within the first 24 hours after ROSC when compared to placebo.
KW - Hemodynamic
KW - In-hospital cardiac arrest
KW - Methylprednisolone
KW - Vasopressin
U2 - 10.1016/j.resuscitation.2023.109922
DO - 10.1016/j.resuscitation.2023.109922
M3 - Journal article
C2 - 37543161
AN - SCOPUS:85167420651
VL - 191
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
M1 - 109922
ER -
ID: 377814069