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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, October 29, 2015

VSE Cocktail en RCP intra-hospitalaria (IHCA)

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