Vasopressin & Methylprednisolone: Time to Add Them to ACLS Protocols?

01/18/22 • 14 min

Saving Lives Podcast: Critical Care w/eddyjoemd

A new study is showing that we should add vasopressin and methylprednisolone to our ACLS protocols as it helps patients achieve ROSC faster. Should they be standard of care? In this episode, we discuss the use of vasopressin and methylprednisolone in cardiac arrest and their potential benefits. We explore the studies that have examined the use of these medications in ACLS protocols and their mechanisms of action. We also review the controversies surrounding their use, including the lack of strong evidence and potential adverse effects. Join us as we weigh the pros and cons of incorporating these drugs into our resuscitation strategies.

Show Notes: https://eddyjoemd.com/vasopressin-methylprednisolone/

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Citations:
Andersen LW, Isbye D, Kjærgaard J, Kristensen CM, Darling S, Zwisler ST, Fisker S, Schmidt JC, Kirkegaard H, Grejs AM, Rossau JRG, Larsen JM, Rasmussen BS, Riddersholm S, Iversen K, Schultz M, Nielsen JL, Løfgren B, Lauridsen KG, Sølling C, Pælestik K, Kjærgaard AG, Due-Rasmussen D, Folke F, Charlot MG, Jepsen RMHG, Wiberg S, Donnino M, Kurth T, Høybye M, Sindberg B, Holmberg MJ, Granfeldt A. Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2021 Oct 26;326(16):1586-1594. doi: 10.1001/jama.2021.16628. PMID: 34587236; PMCID: PMC8482303.

Haukoos J, Douglas IS, Sasson C. Vasopressin and Steroids as Adjunctive Treatment for In-Hospital Cardiac Arrest. JAMA. 2021 Oct 26;326(16):1583-1585. doi: 10.1001/jama.2021.15460. Erratum in: JAMA. 2021 Nov 9;326(18):1874. PMID: 34587235.

Holmberg MJ, Granfeldt A, Mentzelopoulos SD, Andersen LW. Vasopressin and glucocorticoids for in-hospital cardiac arrest: A systematic review and meta-analysis of individual participant data. Resuscitation. 2022 Jan 3;171:48-56. doi: 10.1016/j.resuscitation.2021.12.030. Epub ahead of print. PMID: 34990764.

Show Notes: https://eddyjoemd.com/vasopressin-methylprednisolone/

Previous Episode

Atorvastatin for ICU COVID Patients: Not Ready for Prime Time (Journal Club-ish)

Could atorvastatin (lipitor) help improve outcomes in our COVID patients who are in the ICU? Let's review the evidence from this trial.

Show Notes: https://eddyjoemd.com/atorvastatin-covid/

Citation: MJ. 2022 Jan 7;376:e068407. doi: 10.1136/bmj-2021-068407. PMID: 34996756.

Next Episode

Plasma-lyte vs. Saline (0.9% NaCl) in the Critical Ill: Reviewing the PLUS Trial

The PLUS Trial compared plasma-lyte to 0.9% NaCl (aka normal saline) in patients who were critically ill and needed IV fluids. In this episode, we review the PLUS trial that compared Plasma-lyte to Saline (0.9% NaCl) in critically ill patients. We discuss the rationale behind the trial, its design, and the key findings. We also delve into the implications of the study results and explore how this evidence could impact clinical practice. Additionally, we touch on the broader debate surrounding the use of crystalloid solutions in critical care and discuss the limitations of the study. Whether you are a clinician or a student, this episode will provide you with a deeper understanding of the current evidence-based practices regarding the use of fluids in critically ill patients.

Show Notes: https://eddyjoemd.com/plus-trial/

Citation: Finfer S, Micallef S, Hammond N, Navarra L, Bellomo R, Billot L, Delaney A, Gallagher M, Gattas D, Li Q, Mackle D, Mysore J, Saxena M, Taylor C, Young P, Myburgh J; PLUS Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. N Engl J Med. 2022 Jan 18. doi: 10.1056/NEJMoa2114464. Epub ahead of print. PMID: 35041780.