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Can medicine improve survival after cardiac arrest in hospital?

More people had their heart restarted following resuscitation if they were also given extra medicine directly in their veins, but survival after thirty days was no better than with standard treatment.

2021.09.30 | Lars Elgård Pedersen, Aarhus Universitetshospital

Researchers at Aarhus University Hospital and Aarhus University have collaborated with nine other hospitals in Denmark to test whether treatment with two additional types of medicine can help in restarting the heart, so that more people survive after suffering a cardiac arrest in hospital. The results have just been made public at the International online conference Critical Care Reviews and in the prestigious scientific journal JAMA-Journal of the American Medical Association.

In Denmark, there are approx. 2000 cases annually of a patient suffering a cardiac arrest at a hospital. Unfortunately, the mortality rate is very high, and 30 days after the cardiac arrest only 25-30 per cent are still alive. No medical treatment currently exists which has been proven to increase survival after cardiac arrest in hospital, but two smaller trials have shown that the combination of the hormones vasopressin and methylprednisolone may increase survival.

In a large clinical trial carried out at ten Danish hospitals, 501 patients with cardiac arrest were given the standard treatment, which consists of heart massage and possibly defibrillation and different types of medicine. After drawing lots, half of the patients also received vasopressin and methylprednisolone directly in their veins, while the other half were given a saline solution.

The medications vasopressin and methylprednisolone are natural hormones and are often administered to critically ill patients. In research projects, it has appeared that the two medications can increase the blood flow to the heart during resuscitation.

“Our thesis is that the medications can help restart the heart, and the results from the trial have shown that the number of patients who had their circulation restarted was 42 per cent in the intervention group and 33 per cent in the placebo group – a difference that was statistically significant,” says Lars Wiuff Andersen, who is a medical doctor at Aarhus University Hospital and an associate professor at Aarhus University.

“However, after thirty days there was no difference in the number of patients who survived, and it is still unclear whether this combination of medications can improve survival rates after cardiac arrest in the long term. It would require at least 2,000 patients to investigate this, so we hope that our study can create international interest in collaborating on a larger and more definitive trial.”


The research results – more information

  • Type of study: Randomised clinical trial
  • Partners: Aarhus University and ten hospitals in Denmark: Aarhus University Hospital, Aalborg University Hospital, Randers Regional Hospital, Rigshospitalet, Odense University Hospital, Horsens Regional Hospital, Viborg Regional Hospital, Gentofte Hospital, Herlev Hospital and Zealand University Hospital, Køge.
  • External funding: The Aarhus University Research Foundation, the Department of Clinical Medicine at Aarhus University and the Independent Research Fund Denmark.
  • Vasopressin was supplied free of charge by the company who were not otherwise involved in the trial.
  • Conflicts of interest: No conflicts of interest.

 

Read the scientific article:  https://dx.doi.org/10.1001/jama.2021.16628

Visit the website for the research project: Vasopressin and Methylprednisolone for In-Hospital Cardiac ARREST (VAM-IHCA).


 

Contact

Associate Professor and Medical Doctor Lars W. Andersen
Aarhus University, Department of Clinical Medicine - Research Center for Emergency Medicine and Aarhus Universityhospital, Department of Anaesthesiology and Intensive Care
Mobile: (+45) 51 78 15 11
Email lwandersen@clin.au.dk

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