Health & Medical Lung Health

In-Hospital Cardiac Arrest: A New Weapon in the Fight?

´╗┐In-Hospital Cardiac Arrest: A New Weapon in the Fight?

Commentary


This is one of the first positive advances we have had in the area of ACLS. In this trial, only about 15% of the patients were in ventricular fibrillation or ventricular tachycardia; about 70% were in asystole, and some had pulseless electrical activity. Thus, this does reflect the population that we see when we are in the medical ICU or respond to rapid responses or codes on the general hospital units.

Also of note was that despite having more survivors in the vasopressin and early steroid -- and potentially later steroid -- intervention group, patients paid no morbidity penalty. Often in critical care, we trade off mortality for morbidity, and for patients who survive, as illustrated earlier, we are left with someone who has poor neurocognitive function. In this study, there did not seem to be that penalty. The number of patients who were discharged alive, but with poor performance status, was similar in the 2 intervention groups. The epinephrine/vasopressin/steroid combination improved survival with no accompanying morbidity penalty. That is quite novel and unique.

If these data are replicated in a multicenter international trial with a broader group of patients, they may change practice. This is Andy Shorr, from Washington, DC.



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