Research trial aims to improve cardiac arrest survival

Cardiac arrest is the third leading cause of death in the United States, but survival outcomes vary greatly by location. That’s in part because different hospitals and physicians use different treatment methods.  

Dr. Nick Johnson, professor of emergency and critical-care medicine at the University of Washington School of Medicine, is co-leading a study comparing two commonly used medications to treat shock after cardiac arrest to determine which leads to better survival and other outcome measures. 

People who experience cardiac arrest lose normal heart activity. Of those whose hearts are restarted and survive, up to 70% develop a condition called post-arrest shock. Their heart and blood vessels can't supply enough oxygen-rich blood to their brains and other vital organs, which can cause potentially fatal damage. 

Physicians use medications called vasopressors to stabilize patients with post-arrest shock. The two most-used vasopressors work in different ways; epinephrine works primarily by stimulating the heart to beat faster and stronger while norepinephrine works primarily to stimulate blood vessels to contract. 

Some anecdotal evidence associates these strategies with different survival and recovery outcomes. This trial will test those associations. 

Across 17 U.S. hospitals, the researchers plan to enroll 2,310 adults who have experienced cardiac arrest. The patients will be randomly assigned epinephrine or norepinephrine, and their recovery will be tracked over the course of their hospitalization and for six months post-discharge. 

The project is co-led by Dr. Ari Moskowitz, a critical care physician at Montefiore Einstein, and supported by the Pragmatic Critical Care Research Group at Vanderbilt University. The team is partnering with not only medical professionals but also cardiac arrest survivors, their caregivers, and people who have lost loved ones to cardiac arrest to inform the study design and to identify outcomes. 

“Their perspectives have really changed how we, as researchers, were thinking about this,” said Johnson. 

For example, based on feedback that nothing else mattered if the patients didn’t survive, the team changed the study’s primary outcome from long term outcomes to survival. Researchers will also evaluate patients’ organ function, quality of life, capacity to return to work, and development of post-traumatic stress disorder. 

In addition, Johnson said, “We’re trying to understand whether there are specific characteristics that might predict how patients respond to one strategy over another so that we can personalize care in the future.” 

The Vasopressor Strategy in Cardiac Arrest to Optimize Recovery trial was approved for $11.5 million in research funding by the Patient-Centered Outcomes Research Institute. 

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