TY - JOUR

T1 - Effect of vasopressin and methylprednisolone vs. placebo on long-term outcomes in patients with in-hospital cardiac arrest a randomized clinical trial

AU - Granfeldt, Asger

AU - Sindberg, Birthe

AU - Isbye, Dan

AU - Kjærgaard, Jesper

AU - Kristensen, Camilla M.

AU - Darling, Søren

AU - Zwisler, Stine T.

AU - Fisker, Stine

AU - Schmidt, Jens Christian

AU - Kirkegaard, Hans

AU - Grejs, Anders M.

AU - Rossau, Jørgen R.G.

AU - Larsen, Jacob M.

AU - Rasmussen, Bodil S.

AU - Riddersholm, Signe

AU - Iversen, Kasper

AU - Schultz, Martin

AU - Nielsen, Jakob L.

AU - Løfgren, Bo

AU - Lauridsen, Kasper G.

AU - Sølling, Christoffer

AU - Pælestik, Kim

AU - Kjærgaard, Anders G.

AU - Due-Rasmussen, Dorte

AU - Folke, Fredrik

AU - Charlot, Mette G.

AU - Jepsen, Rikke Malene H.G.

AU - Wiberg, Sebastian

AU - Høybye, Maria

AU - Holmberg, Mathias J.

AU - Andersen, Lars W.

N1 - Funding Information: Funding for the trial was provided by Aarhus University Research Foundation; the Department of Clinical Medicine, Aarhus University; the Central Denmark Region; and the Independent Research Fund Denmark. Empressin and corresponding placebo ampoules were provided free of charge by Amomed Pharma GmbH. Funding Information: Dr Andersen reported receiving grants from Aarhus University Research Foundation, the Department of Clinical Medicine at Aarhus University, and Independent Research Fund Denmark, and nonfinancial support from Amomed Pharma GmbH, which provided trial drug during the conduct of the study. Dr J. Kjærgaard reported receiving grants from the Novo Nordisk Foundation (NNF17OC0028706) outside the submitted work. Dr Lauridsen reported receiving grants from Independent Research Fund Denmark during the conduct of the study. Dr Granfeldt reported receiving personal fees from Noorik Biopharmaceuticals outside the submitted work. No other disclosures were reported. Publisher Copyright: © 2022 The Author(s)

PY - 2022/6

Y1 - 2022/6

N2 - 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.

AB - 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.

KW - In-hospital cardiac arrest

KW - Long-term

KW - Methylprednisolone

KW - Outcomes

KW - Vasopressin

U2 - 10.1016/j.resuscitation.2022.04.017

DO - 10.1016/j.resuscitation.2022.04.017

M3 - Journal article

C2 - 35490936

AN - SCOPUS:85129770063

VL - 175

SP - 67

EP - 71

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -