Geriatric Department, Zhongda Hospital Southeast University, Nanjing, 210008, China.
Department of Emergency Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China.
Eur J Clin Pharmacol. 2020 Dec;76(12):1631-1638. doi: 10.1007/s00228-020-02964-3. Epub 2020 Jul 21.
The role of corticosteroid therapy in patients with cardiac arrest (CA) is uncertain. We aimed to evaluate the efficacy and safety of corticosteroid therapy in CA patients.
Randomised controlled trials were identified using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure and the Chinese Biomedical Literature Database. The primary outcome was overall survival. Secondary outcomes were positive neurological status and probability of sustained restoration of spontaneous circulation (ROSC). Complications were infection and bleeding. Given the significant heterogeneity across previous studies, combining the data using meta-analysis was deemed not appropriate.
Five studies (551 patients) met the criteria. Two studies of co-intervention therapy (corticosteroid, vasopressin and epinephrine protocol) found that this approach could benefit in-hospital CA patient survival rates at hospital discharge, improve neurological function at hospital discharge and yield sustained ROSC rate. However, further two studies failed to demonstrate that corticosteroid therapy alone could improve survival and neurological outcomes among CA patients. Additionally, corticosteroid therapy did not increase the risk of infection and bleeding.
Due to the inherent limitations of the studies in this review, we have not been able to reach definitive conclusions. Larger-scale and better-designed studies are therefore recommended, to further evaluate the potential and rational use of corticosteroid therapy in CA patients.
皮质类固醇治疗在心搏骤停（CA）患者中的作用尚不确定。我们旨在评估皮质类固醇治疗 CA 患者的疗效和安全性。
使用 PubMed、EMBASE、Cochrane 中央对照试验注册库、中国国家知识基础设施和中国生物医学文献数据库检索随机对照试验。主要结局是总体生存率。次要结局是阳性神经状态和持续自主循环恢复（ROSC）的可能性。并发症为感染和出血。鉴于先前研究之间存在显著异质性，认为使用荟萃分析合并数据是不合适的。
符合标准的有 5 项研究（551 例患者）。两项联合干预治疗（皮质类固醇、血管加压素和肾上腺素方案）的研究发现，这种方法可以提高住院 CA 患者出院时的生存率，改善出院时的神经功能，并提高持续 ROSC 率。然而，另外两项研究未能表明皮质类固醇治疗单独可以改善 CA 患者的生存率和神经结局。此外，皮质类固醇治疗并未增加感染和出血的风险。
由于本综述中研究的固有局限性，我们还未能得出明确的结论。因此，建议进行更大规模和设计更好的研究，以进一步评估皮质类固醇治疗 CA 患者的潜在和合理应用。
