In this episode, I’ll discuss high-dose IV vitamin C to mitigate brain injury and organ dysfunction after out-of-hospital cardiac arrest.
After initial excitement on the promise of improving outcomes in sepsis with high-dose IV vitamin C, research ended up settling on the idea that vitamin C either did nothing or caused harm.
There were some reasons to suspect that vitamin C might help patients recover from out of hospital cardiac arrest as it could act as a scavenger of oxygen free radicals, attenuate reperfusion injury, and exert anti-inflammatory effects. A group of researchers published in Intensive Care Medicine a randomized trial to investigate whether IV vitamin C could decrease the burden of post-cardiac arrest syndrome.
Over 270 comatose adults resuscitated from shockable out-of-hospital cardiac arrest randomly received intravenously placebo, or vitamin C at a supplementary (3 g) or supraphysiological (10 g) dose daily for 96 hours.
The primary endpoint was the 96 h change in the resuscitation-sequential organ failure assessment (R-SOFA) score. Secondary endpoints included neurological outcome, myocardial injury, vasopressor- and ventilator-free days, renal function, ICU-acquired weakness, delirium, length of ICU and hospital stay, and 28- and 180-day mortality.
The 10 g vitamin C group experienced 2.5 points less improvement in R-SOFA score compared with placebo which was statistically significant in favor of placebo. There was a trend favoring placebo compared to the 3 g vitamin C group. In addition, the 10 g Vitamin C group had higher troponin T release, worse renal function and worse neurological outcomes.
The authors concluded:
In out-of-hospital cardiac arrest patients, intravenous vitamin C did not reduce organ dysfunction at 96 h, but even worsened organ function outcomes in the 10 g group.
An editorial that was published alongside the study is hopeful that the study may help close the chapter on routine vitamin C administration after cardiac arrest. the editorialists argue that Vitamin C should not be used after OHCA outside clinical trials, and ongoing trials evaluating vitamin C after cardiac arrest should undergo careful review by trial management groups and data safety monitoring boards.
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