Department of Anaesthesiology, CNBC, New Delhi, India.
Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
Resuscitation. 2014 Jul;85(7):855-63. doi: 10.1016/j.resuscitation.2014.03.303. Epub 2014 Apr 2.
Experimental and animal studies suggested that vasopressin may have a favorable survival profile during CPR. This meta-analysis aimed to determine the efficacy of vasopressin in adult cardiac patients.
Meta-analysis of randomized control trials (RCTs) comparing the efficacy of vasopressin containing regimen during CPR in adult cardiac arrest population with an epinephrine only regimen.
A total of 6120 patients from 10 RCTs were included in this meta-analysis. Vasopressin use during CPR has no beneficial impact in an unselected population in ROSC [OR 1.19, 95% CI 0.93, 1.52], survival to hospital discharge [OR 1.13, 95% CI 0.89, 1.43], survival to hospital admission [OR 1.12, 95% CI 0.99, 1.27] and favorable neurological outcome [OR 1.02, 95% CI 0.75, 1.38]. ROSC in "in-hospital" cardiac arrest setting [OR 2.20, 95% CI 1.08, 4.47] is higher patients receiving vasopressin. Subgroup analyses revealed equal or higher chance of ROSC [OR 2.15, 95% CI 1.00, 4.61], higher possibility of survival to hospital discharge [OR 2.39, 95% CI 1.34, 4.27] and favorable neurological outcome [OR 2.58, 95% CI 1.39, 4.79] when vasopressin was used as repeated boluses of 4-5 times titrating desired effects during CPR.
ROSC in "in-hospital" cardiac arrest patients is significantly better when vasopressin was used. A subgroup analysis of this meta-analysis found that ROSC, survival to hospital admission and discharge and favorable neurological outcome may be better when vasopressin was used as repeated boluses of 4-5 times titrated to desired effects; however, overall no beneficial effect was noted in unselected cardiac arrest population.
实验和动物研究表明，加压素在心肺复苏期间可能具有良好的生存预后。本荟萃分析旨在确定加压素在成人心脏患者中的疗效。
荟萃分析比较了心肺复苏期间含有加压素的方案与仅使用肾上腺素的方案在成人心脏骤停人群中的疗效的随机对照试验（RCT）。
共有来自 10 项 RCT 的 6120 名患者纳入本荟萃分析。在未选择的人群中，心肺复苏期间使用加压素对 ROSC 没有有益影响[OR 1.19，95%CI 0.93，1.52]，也不能提高存活率至出院[OR 1.13，95%CI 0.89，1.43]、存活至入院[OR 1.12，95%CI 0.99，1.27]和良好的神经功能结局[OR 1.02，95%CI 0.75，1.38]。在“院内”心脏骤停环境中，ROSC 更高[OR 2.20，95%CI 1.08，4.47]的患者接受加压素治疗。亚组分析显示，ROSC 的机会相等或更高[OR 2.15，95%CI 1.00，4.61]，存活至出院的可能性更高[OR 2.39，95%CI 1.34，4.27]，神经功能结局良好的可能性更高[OR 2.58，95%CI 1.39，4.79]，当在心肺复苏期间使用加压素作为重复推注 4-5 次以滴定所需效果时。
当使用加压素时，“院内”心脏骤停患者的 ROSC 明显更好。本荟萃分析的一个亚组分析发现，当使用加压素作为重复推注 4-5 次以滴定所需效果时，ROSC、存活至入院和出院以及良好的神经功能结局可能更好；然而，在未选择的心脏骤停人群中，总体上没有观察到有益的效果。
