vasopressin + epinephrine + methylprednisolone + hydrocortisone (National and Kapodistrian University of Athens)

This combination therapy, often referred to as the VSE protocol, was developed by researchers at the University of Athens, led by Dr. Spyros Mentzelopoulos, for the treatment of in-hospital cardiac arrest. The protocol involves the administration of vasopressin (20 IU per CPR cycle for up to 5 cycles), epinephrine (1 mg per CPR cycle), and methylprednisolone (40 mg during the first CPR cycle). For patients who achieve return of spontaneous circulation (ROSC) but develop post-resuscitation shock, a follow-up course of stress-dose hydrocortisone (300 mg daily for up to 7 days) is administered. The rationale behind this combination is to utilize the potent vasoconstrictive effects of vasopressin and epinephrine to improve coronary perfusion pressure, while the corticosteroids mitigate the systemic inflammatory response and adrenal insufficiency associated with post-cardiac arrest syndrome. Clinical trials have demonstrated that this approach significantly improves the probability of ROSC and survival to hospital discharge with favorable neurological outcomes compared to standard epinephrine-only resuscitation.

Other names

VSE protocolVasopressin-Epinephrine-Steroids combinationMentzelopoulos protocolvasopressin + epinephrine + steroids