Effect of vasopressin and methylprednisolone vs. placebo on long-term outcomes in patients with in-hospital cardiac arrest a randomized clinical trial

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  • Asger Granfeldt
  • Birthe Sindberg
  • Camilla M. Kristensen
  • Søren Darling
  • Stine T. Zwisler
  • Stine Fisker
  • Jens Christian Schmidt
  • Hans Kirkegaard
  • Anders M. Grejs
  • Jørgen R.G. Rossau
  • Jacob M. Larsen
  • Bodil S. Rasmussen
  • Signe Riddersholm
  • Martin Schultz
  • Jakob L. Nielsen
  • Bo Løfgren
  • Kasper G. Lauridsen
  • Christoffer Sølling
  • Kim Pælestik
  • Anders G. Kjærgaard
  • Dorte Due-Rasmussen
  • Mette G. Charlot
  • Sebastian Wiberg
  • Maria Høybye
  • Mathias J. Holmberg
  • Lars W. Andersen

Objective: The primary results from the Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial have previously been reported. The objective of the current manuscript is to report long-term outcomes. Methods: The VAM-IHCA trial was a multicenter, randomized, double-blind, placebo-controlled trial conducted at ten hospitals in Denmark. Adult patients (age ≥ 18 years) were eligible for the trial if they had an in-hospital cardiac arrest and received at least one dose of epinephrine during resuscitation. The trial drugs consisted of 40 mg methylprednisolone (Solu-Medrol®, Pfizer) and 20 IU of vasopressin (Empressin®, Amomed Pharma GmbH) given as soon as possible after the first dose of epinephrine. This manuscript report outcomes at 6 months and 1 year including survival, survival with favorable neurological outcome, and health-related quality of life. Results: 501 patients were included in the analysis. At 1 year, 15 patients (6.3%) in the intervention group and 22 patients (8.3%) in the placebo group were alive corresponding to a risk ratio of 0.76 (95% CI, 0.41–1.41). A favorable neurologic outcome at 1 year, based on the Cerebral Performance Category score, was observed in 14 patients (5.9%) in the intervention group and 20 patients (7.6%) in the placebo group (risk ratio, 0.78 [95% CI, 0.41–1.49]. No differences existed between groups for favorable neurological outcome and health-related quality of life at either 6 months or 1 year. Conclusions: Administration of vasopressin and methylprednisolone, compared with placebo, in patients with in-hospital cardiac arrest did not improve long-term outcomes in this trial.

OriginalsprogEngelsk
TidsskriftResuscitation
Vol/bind175
Sider (fra-til)67-71
Antal sider5
ISSN0300-9572
DOI
StatusUdgivet - jun. 2022

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