Augmented-Medication CardioPulmonary Resuscitation Trials in out-of-hospital cardiac arrest: a pilot randomized controlled trial

Abstract

Background Previously conducted physician-centered trials on the usefulness of vasopressin have yielded negative results; thus, patient-oriented trials have been warranted. We hypothesize that Augmented-Medication CardioPulmonary Resuscitation could be helpful for selected patients with out-of-hospital cardiac arrest (OHCA). Methods This is a double-blind, single-center, randomized, placebo-controlled trial conducted in the emergency department in a tertiary, university-affiliated hospital in Seoul, Korea. A total of 148 adults with non-traumatic OHCA who had initial diastolic blood pressure (DBP) < 20 mm Hg via invasive arterial monitoring during the early cardiac compression period were randomly assigned to two groups. Patients received a dose of 40 IU of vasopressin or placebo with initial epinephrine. The primary endpoint was a sustained return of spontaneous circulation. Secondary endpoints were survival discharge, and neurologic outcomes at discharge. Results Of the 180 included patients, 32 were excluded, and 148 were enrolled in the trial. A sustained return of spontaneous circulation was achieved by 27 patients (36.5%) in the vasopressin group and 24 patients (32.4%) in the control group (risk difference, 4.1%; P = .60). Survival discharge and good neurologic outcomes did not differ between groups. The trial group had significantly higher median DBPs during resuscitation than the control group (16.0 vs. 14.5 mm Hg, P < 0.01). There was no difference in end-tidal carbon dioxide, acidosis, and lactate levels at baseline, 10 min, and end-time. Conclusion Among patients with refractory vasodilatory shock in OHCA, administration of vasopressin, compared with placebo, did not significantly increase the likelihood of return of spontaneous circulation.

Mortality, morbidity & clinical outcome with different types of vasopressors in out of hospital cardiac arrest patients- a systematic review and meta-analysis

“…In this meta-analysis, 26 studies, including 16 RCTs [ 19 – 34 ] and 10 non-randomized cohort studies [ 35 – 44 ]) that met the predefined criteria considered. The randomized controlled studies comprised 6 single-centre RCTs [ 19 – 21 , 23 , 31 , 32 ], eight 8 multi-centre RCTs, and two 2 single-centre non-RCTs [ 39 , 43 ]. Participants were adults aged 30–80, with two exceptions involving ages 15–94 [ 38 ] and 16–21 [ 26 ].…”

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

“…However, past trials have shown no benefits of vasopressin for ROSC or neurologic outcome over the standard dose of adrenaline, such that its use in CPR was abandoned [ 21 ]. The “Augmented-Medication CardioPulmonary Resuscitation” (AMCPR) trial [ 22 ] is a new pilot RCT on the use of vasopressin during CPR published in 2022. A total of 148 adult non-traumatic OHCA patients with shockable presenting rhythm, who presented a diastolic blood pressure (DBP) < 20 mmHg after insertion of an arterial line at admission to the emergency department, were randomized to receive 40 UI vasopressin or placebo in addition to adrenaline.…”

“…Survival to hospital discharge and good neurologic recovery were also not different between groups. Nevertheless, median DBP during resuscitation was significantly higher in patients receiving vasopressin than in those treated with placebo, likely increasing coronary perfusion pressure during CPR [ 22 ]. Thus, this study does not support the need to modify current recommendations by reintroducing vasopressin as an alternative drug for CPR.…”

“…The conclusion was that a stepwise antiseizure treatment did not yield any benefit in terms of outcome, despite suppressing the malignant EEG pattern.

Figure 4 Number of randomized clinical trials published in 2022 for each link of the chain of survival [ 4 , 9 , 15 , 17 , 22 , 30 , 38 , 45 , 51 , 52 , 60 , 63 , 65 ].

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“… Number of randomized clinical trials published in 2022 for each link of the chain of survival [ 4 , 9 , 15 , 17 , 22 , 30 , 38 , 45 , 51 , 52 , 60 , 63 , 65 ]. …”