Augmented-Medication CardioPulmonary Resuscitation (AMCPR) trial: a study protocol for a randomized controlled trial

Diastolic blood pressures and end tidal carbon dioxides during cardiopulmonary resuscitations and their association with outcomes in adult out-of-hospital cardiac arrest patients: A preplanned secondary analysis of the Augmented Medication CardioPulmonary resuscitation (AMCPR) trial

BACKGROUND

The optimal targets for diastolic blood pressure (DBP) and end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) and their association with outcomes remain unclear. This study aimed to evaluate the association between DBP and ETCO2 and the return of spontaneous circulation (ROSC) during CPR.

METHODS

This study was a preplanned sub-analysis of the Augmented Medication CardioPulmonary Resuscitation (AMCPR) trial. We extracted initial (within 5 min), follow-up (around 10 min), and delta (follow-up minus initial) values of DBP and ETCO2 from the registry. The primary outcome was sustained ROSC (≥20 min).

RESULTS

The study included 264 patients, mostly male (69.3%) and with a median age of 74 years old. Of these patients, 101 (38.3%) achieved sustained ROSC. Patients with sustained ROSC had statistically higher initial, follow-up, and delta values of DBP compared to those without ROSC. However, the levels of ETCO2 were similar between the two groups, except for follow-up values. Follow-up DBP above 26.5 and delta DBP above 6.5 were independently associated with sustained ROSC (adjusted odds ratio, aOR = 10.03, 95% confidence interval, CI = 3.64-27.66, p < 0.01, and aOR = 4.83, 95% CI = 1.90-12.26, p < 0.01).

CONCLUSION

Monitoring DBP during resuscitation in patients with cardiac arrest may provide additional information about successful initial resuscitation. Improving certain levels of DBP may influence outcomes.

Augmented-Medication CardioPulmonary Resuscitation Trials in out-of-hospital cardiac arrest: a pilot randomized controlled trial

BACKGROUND

Previously conducted physician-centered trials on the usefulness of vasopressin have yielded negative results; thus, patient-oriented trials have been warranted. We hypothesize that Augmented-Medication CardioPulmonary Resuscitation could be helpful for selected patients with out-of-hospital cardiac arrest (OHCA).

METHODS

This is a double-blind, single-center, randomized, placebo-controlled trial conducted in the emergency department in a tertiary, university-affiliated hospital in Seoul, Korea. A total of 148 adults with non-traumatic OHCA who had initial diastolic blood pressure (DBP) < 20 mm Hg via invasive arterial monitoring during the early cardiac compression period were randomly assigned to two groups. Patients received a dose of 40 IU of vasopressin or placebo with initial epinephrine. The primary endpoint was a sustained return of spontaneous circulation. Secondary endpoints were survival discharge, and neurologic outcomes at discharge.

RESULTS

Of the 180 included patients, 32 were excluded, and 148 were enrolled in the trial. A sustained return of spontaneous circulation was achieved by 27 patients (36.5%) in the vasopressin group and 24 patients (32.4%) in the control group (risk difference, 4.1%; P = .60). Survival discharge and good neurologic outcomes did not differ between groups. The trial group had significantly higher median DBPs during resuscitation than the control group (16.0 vs. 14.5 mm Hg, P < 0.01). There was no difference in end-tidal carbon dioxide, acidosis, and lactate levels at baseline, 10 min, and end-time.

CONCLUSION

Among patients with refractory vasodilatory shock in OHCA, administration of vasopressin, compared with placebo, did not significantly increase the likelihood of return of spontaneous circulation.