American Heart Association ACLS 2020 does not provide a recommendation for the specific use of vasopressor infusions to maintain MAP after ROSC. Only recently, the European ERC suggests noradrenaline for such scenarios. This could imply clinical equipoise since there are no recommendations against certain vasopressors. We believe that a majority of ED practice involves initiating epinephrine infusions as first-line vasopressor therapy post-ROSC, however this is unknown and has never been elucidated to our knowledge.
This survey will be sent to U.S. pharmacists to gain a geographically diverse sample to assess the use of vasopressors in the setting of post-ROSC cardiac arrest. Since there is no consensus in U.S. guidelines (AHA-ACLS) or a significant body of literature to support which vasopressor to use in such scenarios, we aim to determine if there is perceived clinical equipoise surrounding vasopressor choice. To help determine this we will send a 10-15 question survey to pharmacists in Emergency Departments across the country to assess clinical practice patterns. Various observational analysis of this type is inherently difficult, and a randomized controlled trial would be costly and retrospective analysis is indeterminate and statistically challenging to incorporate confounding. There are no prospective randomized trials currently registered in clinicaltrials.gov on this matter, therefore we feel a survey would give insight into current practice. We have no formal hypothesis since this is an exploratory survey to gain insight into practice.