Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China.
J Int Med Res. 2020 May;48(5):300060520921670. doi: 10.1177/0300060520921670.
The effect of steroid use on outcomes in patients with cardiac arrest (CA) remains controversial. We systematically reviewed the literature to investigate whether steroid use after CA increased the return of spontaneous circulation (ROSC) rate and survival to discharge in patients with CA.
PubMed, Embase, CNKI, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) and observational studies on the effect of steroid use on outcomes in adults with CA. The outcomes were ROSC and survival to discharge.
Seven studies (four RCTs and three observational studies) were included. Pooled analysis suggested that steroid use was associated with increased ROSC in patients with CA. Steroid use was significantly associated with survival to discharge, which was a consistent finding in RCTs and observational studies. Subgroup analysis based on the time of drug administration (during cardiopulmonary resuscitation [CPR] vs. after CA) showed that steroid use during CPR and after CA were significantly associated with an increased rate of ROSC and survival to discharge.
Current evidence indicates that steroid use after CA could increase ROSC and survival to discharge in patients with CA. However, high-quality and adequately powered RCTs are warranted.
类固醇在心脏骤停（CA）患者中的应用效果仍存在争议。我们系统地回顾了文献，以调查 CA 后类固醇的使用是否会增加 CA 患者自主循环恢复（ROSC）率和出院存活率。
检索了 PubMed、Embase、CNKI 和 Cochrane 对照试验中心注册数据库中关于类固醇对成人 CA 患者结局影响的随机对照试验（RCT）和观察性研究。结局为 ROSC 和出院存活率。
共纳入了 7 项研究（4 项 RCT 和 3 项观察性研究）。汇总分析表明，类固醇的使用与 CA 患者 ROSC 增加有关。类固醇的使用与出院存活率显著相关，这一结果在 RCT 和观察性研究中是一致的。基于给药时间（CPR 期间与 CA 后）的亚组分析表明，CPR 期间和 CA 后使用类固醇均与 ROSC 率和出院存活率的增加显著相关。
目前的证据表明，CA 后使用类固醇可能会增加 CA 患者的 ROSC 和出院存活率。然而，仍需要高质量和充分有力的 RCT 来进一步证实。
