A Combo for Cardiac Arrests

Brain damage after cardiac arrest can be prevented with a combo of CPR and meds

(RxWiki News) If someone's heart stops beating, CPR can be a lifesaver. But the risk of brain damage is still present. Fortunately, there are therapies that can lower the risk of this brain damage.

Patients who suffer cardiac arrest in the hospital may have better outcomes with a combination of therapies given during and after CPR, says a new study.

According to the results of this study, a combination of two medications to raise blood pressure during CPR, followed by steroids, led to improved survival and better brain function in patients after discharge.

"Learn CPR — you may save someone's life."

This study was conducted by Spyros D. Mentzelopoulos, MD, PhD, of the University of Athens Medical School in Athens, Greece, and colleagues.

The aim of this study was to find out if treating cardiac arrest patients with a combination of two medications that increase blood flow during CPR and then steroids after CPR improved survival and neurological outcome.

When patients suffer cardiac arrest in the hospital, they receive cardiopulmonary resuscitation (CPR). During CPR, patients are given a series of chest compressions to improve blood flow which, in turn, may get the heart to start beating again.

Though patients may survive after CPR, there is a possibility that brain damage occurred during the brief period when their hearts stopped beating. Doctors aim to minimize this damage using different therapies.

This study looked at 268 patients who had cardiac arrest and needed CPR. Patients in the study group (130 patients) received a combination of vasopressin and epinephrine, two medications that raise blood pressure.

The comparison group (138 patients) received epinephrine and an injection of saline (a solution containing salt) with no medications added. After CPR, the patients in the study group received a steroid. The patients in the comparison group again received a saline injection.

The researchers looked at return of circulation and survival until hospital discharge in both groups. The neurological status was also measured using in-person interviews and medical records review. Favorable neurological outcomes meant that these patients were conscious and were able to live and work normally.

The researchers found that patients who received vasopressin, epinephrine and steroids had a higher chance (83.9 percent of patients) of blood circulation returning to normal, in contrast to the comparison group (65.9 percent of patients).

At the time of hospital discharge, 13.9 percent of patients in the study group that received a combination of drugs had a favorable neurological outcome as compared to 5.1 percent of patients in the comparison group. In other words, 13.9 percent of patients in the study group were conscious and were able to live and work normally at the time they left the hospital.

Thus, overall, the study found that, in patients with cardiac arrest requiring medications to raise blood pressure, a combination of epinephrine, vasopressin and steroids improved patient outcomes.

The authors noted a couple of limitations of their study. The exact mechanism of action of the medications, or how the medications actually work, was not known. Also, the small sample size meant that outcomes after one year could not be analyzed in a reliable manner.

This study was published July 16 in the Journal of the American Medical Association (JAMA).

The study received funding from the Greek Society of Intensive Care Medicine and the project "Synergasia" of the Greek Ministry of Education. No conflicts of interest were reported by the authors.

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Review Date: 
July 15, 2013