R.E.B.E.L. EM - Posted by Darrel Hughes
"The newly published 2015 AHA guidelines recommend that:
“In IHCA, the combination of Vasopressin, Epinephrine, and Methylprednisolone and post-arrest Hydrocortisone as described by Mentzelopoulos et al. maybe considered; however, further studies are needed before recommending the routine use of this strategy (Class IIb, LOE C-LD)”
Mentzelopoulos et al. have published two separate randomized, double-blind, placebo-controlled studies out of Greece examining the role of this Vasopressin, Steroid, and Epinephrine (VSE) cocktail. These studies looked at in-hospital cardiac arrest for patients and enrolled patients immediately with non-shockable rhythms or patients in refractory VFib/VTach. The first study included 100 patients from a single center, while the second study included 268 patients from multiple centers."
Clinical Bottom Line
- The VSE cocktail increases neurologically favorable survival to hospital discharge for IHCA with a NNT = 12
- Prior investigations of vasopressin and epinephrine should be interpreted cautiously due to delays in initiation to basic life support and time to vasopressor therapy
- Early administration of steroids attenuates complications of post-resuscitation care such as inflammatory mediated ischemic/reperfusion injury, post-resuscitation shock, and adrenal insufficiency
http://rebelem.com/why-you-should-more-than-consider-a-vasopressin-steroid-and-epinephrine-vse-cocktail/