Efficacy of vasopressin, steroid, and epinephrine protocol for in-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis
Danish Iltaf Satti1
Yan Hiu Athena Lee1
Keith Sai Kit Leung2
Jeremy Man Ho Hui3
Thompson Ka Ming Kot4
Arslan Babar5
Gauranga Mahalwar5
Abraham KC Wai6
Tong Liu7
Leonardo Roever8
Gary Tse9
Jeffrey Shi Kai Chan1
International Health Informatics Study(IHIS)Network
1.Cardiovascular Analytics Group,Hong Kong,China-UK Collaboration2.Cardiovascular Analytics Group,Hong Kong,China-UK Collaboration;Emergency Medicine Unit,Li Ka Shing Fac-ulty of Medicine,The University of Hong Kong,Hong Kong,China;Aston Medical School,Faculty of Health&Life Sciences,Aston University,Birmingham,United Kingdom3.Cardiovascular Analytics Group,Hong Kong,China-UK Collaboration;Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China4.Department of Anaesthesia and Pain Service,Princess Margaret Hospital,Lai Chi Kok,Kowloon,Hong Kong,China5.Department of Medicine,Cleveland Clinic Foundation,Cleveland,USA6.Aston Medical School,Faculty of Health&Life Sciences,Aston University,Birmingham,United Kingdom7.Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease,Department of Cardiology,Tianjin Institute of Cardi-ology,Second Hospital of Tianjin Medical University,Tianjin,China8.Department of Clinical Research,Federal Uni-versity of Uberlandia,Uberlandia,Brazil9.Cardiovascular Analytics Group,Hong Kong,China-UK Collaboration;Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease,Department of Cardiology,Tianjin Institute of Cardi-ology,Second Hospital of Tianjin Medical University,Tianjin,China;Kent and Medway Medical School,Canterbury,Kent,United Kingdom
摘要：OBJECTIVES To assess the effect of vasopressin, steroid and epinephrine (VSE) combination therapy on return of spontan-eous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and test the conclusiveness of evidence using trial sequential ana-lysis (TSA). METHODS The systematic search included PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that included adult patients with IHCA, with at least one group receiving combined VSE therapy were selected. Data was extracted independently by two reviewers. The main outcome of interest was ROSC. Other out-comes included survival to hospital discharge or survival to 30 and 90 days, with good neurological outcomes. RESULTS We included a total of three RCTs (n = 869). Results showed that VSE combination therapy increased ROSC (risk ra-tio = 1.41; 95％ CI: 1.25-1.59) as compared to placebo. TSA demonstrated that the existing evidence is conclusive. This was also validated by the alpha-spending adjusted relative risk (1.32 [1.16, 1.49], P < 0.0001). Other outcomes could not be meta-analysed due to differences in timeframe in the included studies. CONCLUSIONS VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC. Fu-ture trials of VSE therapy should evaluate survival to hospital discharge, neurological function and long-term survival.
机标关键词：meta-analysisprotocolreviewwitharrestcardiaccontrolledefficacy
论文发表日期：2022-09-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：7( 705-711 )