Vasopressin and glucocorticoids compared to placebo, improved return of spontaneous circulation among adults for in-hospital cardiac arrest, says recent findings in Resuscitation.
Despite advancement in the management of cardiac arrest over the past decades, outcomes remain dismal. The treatment of cardiac arrest includes basic life support (e.g., chest compressions and ventilations), advanced life support (e.g., defibrillation and drugs), and post-cardiac arrest care. However, there is limited evidence to support many of the advanced therapies currently used during cardiac arrest and there is an unmet need for new pharmacological interventions to improve patient outcomes.
The study question was framed using the PICO (Population, Intervention, Comparison, Outcome) format in adult patients with cardiac arrest in any setting (out-of-hospital or in-hospital), does vasopressin and glucocorticoids provided during cardiac arrest, as compared to no vasopressin and no glucocorticoids.
The PRISMA-IPD guidelines were followed and researchers searched Medline, Embase, and the Cochrane Library for randomized trials comparing vasopressin and glucocorticoids to placebo during cardiac arrest.
The population included adults with cardiac arrest in any setting and Pairs of investigators reviewed studies for relevance, extracted data, and assessed risk of bias. Meta-analyses were conducted using individual participant data. A Bayesian framework was used to estimate posterior treatment effects assuming various prior beliefs. The certainty of evidence was evaluated using GRADE.
Among adult patients with an in-hospital cardiac arrest, the use of vasopressin and glucocorticoids when compared to placebo, resulted in improved return of spontaneous circulation.
Authors said that larger trials are needed to determine whether there is an effect on longer-term survival and favorable neurological outcome.
