Title: Vasopressin, Steroids, and Epi….Oh my! A new cocktail for cardiac arrest?
题目：血管加压素，激素和肾上腺素。。。天哪！心脏骤停的一个新的混合剂
Author作者: Haney Mallemat

The efficacy of epinephrine during out-of hospital cardiac arrest has been questioned in recent years, especially with respect to neurologic outcomes (ref#1).
近几年来对肾上腺素在医院外心脏骤停的作用已有质疑，尤其是对神经系统预后的影响。
A recent study demonstrated both a survival and neurologic benefit to using epinephrine during in-hospital cardiac arrest when used in combination with vasopressin and methylprednisolone.
最近的一项研究显示，在院内心脏骤停抢救时，当肾上腺素与血管加压素和甲基强的松龙联合使用时，可改善生存率和神经系统预后。
Researchers in Greece randomized 268 consecutive patients with in-hospital cardiac arrest to receive either epinephrine + placebo (control group; n=138) or vasopressin, epinephrine, and methylprednisolone (intervention arm; n=130)
希腊的研究人员对268例院内心脏骤停患者随机的分成肾上腺素+安慰剂组（对照组，n = 138 ）或血管加压素，肾上腺素及甲基强的松龙组（治疗组，n = 130 ）。
Vasopressin (20 IU) was given with epinephrine each CPR cycle for the first 5 cycles; Epinephrine was given alone thereafter (if necessary)
在心肺复苏的前5个周期，血管加压素（ 20 IU ）与肾上腺素同时给予；然后只给肾上腺素（如果有必要的话）
Methylprednisolone (40 mg) was only given during the first CPR cycle.
甲基强的松龙（ 40毫克）只在第一个CPR周期给予。
If there was return of spontaneous circulation (ROSC) but the patient was in shock, 300 mg of methylprednisolone was given daily for up to 7 days.
如果自主循环（ ROSC ）恢复 ，但病人处于休克状态，7天内每天要给300毫克的甲基强的松龙。◦
Primary study end-points were ROSC for 20 minutes or more and survival to hospital discharge while monitoring for neurological outcome
主要研究指标为，ROSC超过20分钟，存活出院并监测神经预后
The results were that patients in the intervention group had a statistically significant:
结果发现，治疗组患者在在下列几方面有统计学意义：
probability of ROSC for > 20 minutes (84% vs. 66%)
ROSC恢复> 20分钟（ 84％对66％ ）
survival with good neurological outcomes (14% vs. 5%)
具有良好的神经系统的恢复（ 14％对5％ ）
survival if shock was present post-ROSC (21% vs. 8%)
ROSC后出现休克 （21％比8％ ）
better hemodynamic parameters, less organ dysfunction, and better central venous saturation levels
较好的血流动力学参数，较轻的器官功能障碍，和更好的中央静脉血氧饱和度水平
Bottom-line: This study may present a promising new therapy for in-hospital cardiac arrest and should be strongly considered.
要点：这项研究可能会提示一个充满希望的治疗院内心脏骤停新方法，应该给予重点考虑。
References 参考文献：
Jacobs, I. et. al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomized double-blind placebo-controlled trial. Resuscitation 2011 Sep;82(9):1138-43
2. Spyros Mentzelopoulos et al. Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest. A Randomized Clinical Trial. JAMA 2013;310(3):270-279.