血管加压素与甲泼尼龙对院内心脏骤停后血流动力学的影响——VAM-IHCA 试验的事后分析。

Vasopressin and methylprednisolone and hemodynamics after in-hospital cardiac arrest - A post hoc analysis of the VAM-IHCA trial.

机构信息

Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Anaesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark.

Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.

出版信息

Resuscitation. 2023 Oct;191:109922. doi: 10.1016/j.resuscitation.2023.109922. Epub 2023 Aug 3.

DOI:10.1016/j.resuscitation.2023.109922

PMID:37543161

Abstract

INTRODUCTION

The Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial demonstrated a significant improvement in return of spontaneous circulation (ROSC) with no clear effect on long-term outcomes. The objective of the current manuscript was to evaluate the hemodynamic effects of intra-cardiac arrest vasopressin and methylprednisolone during the first 24 hours after ROSC.

METHODS

The VAM-IHCA trial randomized patients with in-hospital cardiac arrest to a combination of vasopressin and methylprednisolone or placebo during the cardiac arrest. This study is a post hoc analysis focused on the hemodynamic effects of the intervention after ROSC. Post-ROSC data on the administration of glucocorticoids, mean arterial blood pressure, heart rate, blood gases, vasopressor and inotropic therapy, and sedation were collected. Total vasopressor dose between the two groups was calculated based on noradrenaline-equivalent doses for adrenaline, phenylephrine, terlipressin, and vasopressin.

RESULTS

The present study included all 186 patients who achieved ROSC in the VAM IHCA-trial of which 100 patients received vasopressin and methylprednisolone and 86 received placebo. The number of patients receiving glucocorticoids during the first 24 hours was 22/86 (26%) in the placebo group and 14/100 (14%) in the methylprednisolone group with no difference in the cumulative hydrocortisone-equivalent dose. There was no significant difference between the groups in the mean cumulative noradrenaline-equivalent dose (vasopressin and methylprednisolone: 603 ug/kg [95CI% 227; 979] vs. placebo: 651 ug/kg [95CI% 296; 1007], mean difference -48 ug/kg [95CI% -140; 42.9], p = 0.30), mean arterial blood pressure, or lactate levels. There was no difference between groups in arterial blood gas values and vital signs.

CONCLUSION

Treatment with vasopressin and methylprednisolone during cardiac arrest caused no difference in mean arterial blood pressure, vasopressor use, or arterial blood gases within the first 24 hours after ROSC when compared to placebo.

摘要

简介

血管加压素和甲基强的松龙治疗院内心搏骤停（VAM-IHCA）试验显示，在恢复自主循环（ROSC）方面有显著改善，但对长期结果没有明显影响。本手稿的目的是评估 ROSC 后 24 小时内心脏骤停期间使用血管加压素和甲基强的松龙对内源性的血流动力学影响。

方法

VAM-IHCA 试验将院内心搏骤停的患者随机分配到血管加压素和甲基强的松龙或安慰剂的组合中，在心脏骤停期间使用。本研究是一项事后分析，重点是 ROSC 后干预的血流动力学效果。收集 ROSC 后皮质类固醇、平均动脉压、心率、血气、血管加压素和正性肌力治疗以及镇静的数据。根据肾上腺素、苯肾上腺素、特利加压素和血管加压素的去甲肾上腺素等效剂量计算两组之间的总血管加压素剂量。

结果

本研究包括 VAM IHCA 试验中所有达到 ROSC 的 186 名患者，其中 100 名患者接受血管加压素和甲基强的松龙治疗，86 名患者接受安慰剂治疗。在安慰剂组中，24 小时内接受皮质类固醇治疗的患者有 22/86（26%），而在甲基强的松龙组中有 14/100（14%），皮质醇等效剂量无差异。两组间平均累积去甲肾上腺素等效剂量（血管加压素和甲基强的松龙：603ug/kg[95CI%227；979]vs.安慰剂：651ug/kg[95CI%296；1007]，平均差异-48ug/kg[95CI%-140；42.9]，p=0.30）、平均动脉压或乳酸水平无显著差异。两组间动脉血气值和生命体征无差异。