VAM-IHCA TRIAL

Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients with In-Hospital Cardiac Arrest(IHCA)

IHCA has been poorly researched when compared to out of hospital cardiac arrest(OOHCA).

In 2013, the VSE TRIAL showed improved neurologically favourable survival after using vasopressin and steroid alongside epinephrine, in patients of IHCA.

VAM-IHCA was an investigator initiated, multicenter, randomized, placebo-controlled, parallel group, double-blind, superiority trial.

512 patients were randomized and 501 patients were analysed. They were all enrolled from 10 hospitals in Denmark. Data were collected from October 2018- January 2021.

The enrolled patients had IHCA AND HAD RECEIVED ATLEAST 1 dose of adrenaline. Vasopressin(20 IU) and Methylprednisolone(40 mg) were administered after the first dose of ADR. Additional doses of vasopressin or placebo were administered after each additional dose of ADR(upto 4 times).

Outcome:

Primary Outcome:

ROSC:VAM(42%) vs PLACEBO(33%).

Secondary Outcome:

1. 30 DAY SURVIVAL:VAM(9.7%) vs PLACEBO(12%).
2. 90 DAY SURVIVAL:VAM(8.4%) vs PLACEBO(9.1%).
3. 30 AND 90 DAY FAVOURABLE NEUROLOGICAL OUTCOME:INSIGNIFICANT DIFFERENCE.

Safety Outcome:

1. HYPERGLYCEMIA:VAM(77%) vs PLACEBO(73%).
2. HYPERNATREMIA:VAM(28%) vs PLACEBO(31%).
3. PNEUMONIA:VAM(21%) vs PLACEBO(17%).
4. GI BLEEDING:VAM(5%) vs PLACEBO(3%).

So, in conclusion the administration of vasopressin and methylprednisolone,compared to placebo,significantly increased the likelihood of ROSC.Uncertainty remains as to whether this translates to long term survival benefit or harm.

Whether this evidence is sufficient to incorporate vasopressin and steroid in cardiac arrest algorithms is a question that could be answered by further trials only!!

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