Vasopressors, antiarrhythmics, oxygen, and intubation in out-of-hospital cardiac arrest: possibly less is more

Out-of-hospital cardiac arrest (OHCA) is a major cause of death in Western countries. Recently, a series of randomised controlled trials assessed the effect of major ALS interventions: tracheal intubation, vasopressor and antiarrhythmic drugs during CPR, and oxygenation, ventilation and hemodynamic management strategies after return of spontaneous circulation (ROSC) Antiarrhythmics and vasopressors increase short-term survival but this should be balanced against the risk of futility and an increased number of survivors with severe HIBI. Targeted ventilation and haemodynamic strategies increase brain oxygenation, but without any beneficial effect on surrogate markers of HIBI. It appears less may be more when it comes to many commonly used advanced interventions during CPR and afterROSC—future research needs to give us a better understanding of the circumstances when these interventions improve patient outcomes.