In view of the presented discussion/evidence and until publication of new evidence from a large, ongoing Swedish RCT, we suggest that vasopressin-steroids-epinephrine (VSE) might be considered in in-hospital cardiac arrest (IHCA). However, the frailty/fragility of the corrected meta-analysis results needs to be considered.

Advanced life support (ALS) objectives include maximization of coronary perfusion pressure (CPP) for prompt return of spontaneous circulation (ROSC) and minimization of cardiac arrest-associated ischemia–reperfusion injury.

Epinephrine, the standard ALS vasopressor, improves ROSC rate, with uncertain effect on neurological outcome.

Epinephrine efficacy is limited by its potential to cause arrhythmias, myocardial ischemic contracture, and cerebral microcirculatory dysfunction.

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