Vasopressin, steroids, and epinephrine in out-of-hospital cardiac arrest - a protocol for a randomized controlled trial (OHCA REVIVES trial)

Ying-Chih Ko^{1

2

3}, Yu-You Lin⁴, Wen-Shuo Yang⁵, Yu-Ting Tseng⁵, Teng-Jie Huang⁶, Chi-Ting Lai⁶, Song-Yao Huang⁶, Chin-Ming Hsieh⁶, Pen-Li Wang⁶, Huei-Han Chen⁴, Kuan-Yu Chen⁴, Jen-Tang Sun^{7

8}, Chin-Hao Chang⁹, Tzu-Pin Lu¹⁰, Matthew Huei-Ming Ma^{2

11

12}, Wen-Chu Chiang^{2

11

12}

Affiliations

¹ Section of Emergency Medicine, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
² Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁴ New Taipei City Fire Department, New Taipei City, Taiwan.
⁵ Emergency Medical Services Division, Taipei City Fire Department, Taipei, Taiwan.
⁶ Taipei City Fire Department, Taipei City, Taiwan.
⁷ Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
⁸ General Education Center, Lunghwa University of Science and Technology, Taoyuan City, Taiwan.
⁹ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Institute of Health Data Analytics and Statistics, Department of Public Health, National Taiwan University, Taipei, Taiwan.
¹¹ Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliu City, Taiwan.
¹² Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.

PMID: 41399685
PMCID: PMC12702410
DOI: 10.1016/j.resplu.2025.101163

Vasopressin, steroids, and epinephrine in out-of-hospital cardiac arrest - a protocol for a randomized controlled trial (OHCA REVIVES trial)

Ying-Chih Ko et al. Resusc Plus. 2025.

. 2025 Nov 18:27:101163.

doi: 10.1016/j.resplu.2025.101163. eCollection 2026 Jan.

Authors

Affiliations

¹ Section of Emergency Medicine, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
² Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁴ New Taipei City Fire Department, New Taipei City, Taiwan.
⁵ Emergency Medical Services Division, Taipei City Fire Department, Taipei, Taiwan.
⁶ Taipei City Fire Department, Taipei City, Taiwan.
⁷ Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
⁸ General Education Center, Lunghwa University of Science and Technology, Taoyuan City, Taiwan.
⁹ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Institute of Health Data Analytics and Statistics, Department of Public Health, National Taiwan University, Taipei, Taiwan.
¹¹ Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliu City, Taiwan.
¹² Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.

PMID: 41399685
PMCID: PMC12702410
DOI: 10.1016/j.resplu.2025.101163

Abstract

Objective: Several clinical trials have shown promising results for the vasopressin-steroid-epinephrine (VSE) triple therapy in patients experiencing in-hospital cardiac arrest (IHCA); however, this treatment strategy has not yet been studied in the prehospital setting. The OHCA REVIVES (A Randomized Clinical Trial of Patient Outcomes Following Out-of-Hospital Cardiac Arrest Receiving Epinephrine Versus In-together Vasopressin, Epinephrine, and Steroid) trial aims to evaluate the effectiveness of the VSE combined therapy in improving clinical outcomes in patients with out‑of‑hospital cardiac arrest (OHCA).

Methods: The OHCA REVIVES trial is an investigator-initiated, multicenter, superiority cluster randomized controlled trial. Adult non-traumatic patients with OHCA treated by six participating advanced ambulance teams in Taipei and New Taipei City, Taiwan will be included. Biweekly randomized clusters of participating advanced ambulance teams were assigned to administer either VSE combined therapy or standard care during cardiac arrest. The primary outcome is sustained return of spontaneous circulation (ROSC ≥ 2 h), and key secondary outcomes include prehospital ROSC, survival to hospital discharge, and survival with favorable neurologic outcomes (cerebral performance category score ≤ 2) at hospital discharge. A total of 1344 patients will be included.

Conclusion: The OHCA REVIVES trial is expected to provide new insights into pharmacological strategies for the treatment of OHCA.Trial registration:ClinicalTrials.gov (identifier: NCT06203847; date registered: January 12, 2024).

Keywords: Cardiac arrest; Clinical trial protocol; Epinephrine; Steroid; Vasopressin.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing financial interests or personal relationships that could have influenced the work reported in this paper.

Figures

**Fig. 1**
Proposed CONSORT flow diagram. OHCA, out-of-hospital cardiac arrest; VSE, vasopressin-steroid-epinephrine; ITT, intention-to-treat.

**Fig. 2**
Ampoule dispensing device: (A) three-dimensional model design schematic and (B) completed final product.

See this image and copyright information in PMC

References

1. Martin S.S., Aday A.W., Allen N.B., et al. 2025 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2025;151:e41–e660. - PMC - PubMed
1. Lin H.Y., Chien Y.C., Lee B.C., et al. Outcomes of out-of-hospital cardiac arrests after a decade of system-wide initiatives optimising community chain of survival in Taipei city. Resuscitation. 2022;172:149–158. - PubMed
1. Wang C.Y., Wang J.Y., Teng N.C., et al. The secular trends in the incidence rate and outcomes of out-of-hospital cardiac arrest in Taiwan–a nationwide population-based study. PLoS One. 2015;10 - PMC - PubMed
1. Myat A., Song K.J., Rea T. Out-of-hospital cardiac arrest: current concepts. Lancet. 2018;391:970–979. - PubMed
1. Ong M.E.H., Perkins G.D., Cariou A. Out-of-hospital cardiac arrest: prehospital management. Lancet. 2018;391:980–988. - PubMed

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov

LinkOut - more resources

Full Text Sources
- Elsevier Science
- PubMed Central
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Vasopressin, steroids, and epinephrine in out-of-hospital cardiac arrest - a protocol for a randomized controlled trial (OHCA REVIVES trial)

Affiliations

Vasopressin, steroids, and epinephrine in out-of-hospital cardiac arrest - a protocol for a randomized controlled trial (OHCA REVIVES trial)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Associated data

LinkOut - more resources

Full Text Sources

Medical