Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR, United States.
Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR, United States.
Am J Emerg Med. 2020 Sep;38(9):1921-1934. doi: 10.1016/j.ajem.2020.05.083. Epub 2020 May 29.
Esmolol has been proposed as a viable adjunctive therapy for pre-hospital refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT).
We performed a systematic review and meta-analysis to assess the effectiveness of esmolol on pre-hospital refractory VF/pVT, compared with standard of care.
MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible studies. Two investigators independently extracted relevant data and assessed the methodological quality of each included study using the ROBINS-I tool. The quality of evidence for summary estimates was assessed according to GRADE guidelines. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for each outcome of interest were calculated.
The search yielded 3253 unique records, of which two studies were found to be in accordance with the research purpose, totaling 66 patients, of whom 33.3% (n = 22) received esmolol. Additional evidence was provided in the paper but was not relevant to the analysis and was therefore not included. Esmolol was likely associated with an increased rate of survival to discharge (RR 2.82, 95% CI 1.01-7.93, p = 0.05) (GRADE: Very low) and survival with favorable neurological outcome (RR 3.44, 95% CI 1.11-10.67, p = 0.03) (GRADE: Very low). Similar results were found for return of spontaneous circulation (ROSC) (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low) and survival to intensive care unit (ICU)/hospital admission (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low).
The effectiveness of esmolol for refractory VF/pVT remains unclear. Trial sequential analysis (TSA) indicates that the evidence is inconclusive and that further trials are required in order to reach a conclusion. Therefore, it is imperative to continue to accumulate evidence in order to obtain a higher level of scientific evidence.
艾司洛尔已被提议作为院前难治性心室颤动/无脉性室性心动过速（VF/pVT）的可行辅助治疗方法。
我们进行了系统评价和荟萃分析，以评估与标准治疗相比，艾司洛尔对院前难治性 VF/pVT 的疗效。
检索 MEDLINE、Embase、Scopus 和 Cochrane 对照试验中心注册库（CENTRAL），以寻找合格的研究。两名研究者独立提取相关数据，并使用 ROBINS-I 工具评估纳入研究的方法学质量。根据 GRADE 指南评估汇总估计的证据质量。计算每个感兴趣结局的汇总风险比（RR）及其 95%置信区间（CI）。
检索得到 3253 条独特记录，其中两项研究符合研究目的，共纳入 66 名患者，其中 33.3%（n=22）接受了艾司洛尔治疗。在论文中还提供了其他证据，但与分析无关，因此未纳入。艾司洛尔可能与更高的出院存活率（RR 2.82，95%CI 1.01-7.93，p=0.05）（GRADE：极低）和具有良好神经结局的存活率（RR 3.44，95%CI 1.11-10.67，p=0.03）（GRADE：极低）相关。同样的结果也见于自主循环恢复（ROSC）（RR 2.63，95%CI 1.37-5.07，p=0.004）（GRADE：极低）和重症监护病房（ICU）/住院存活率（RR 2.63，95%CI 1.37-5.07，p=0.004）（GRADE：极低）。
艾司洛尔治疗难治性 VF/pVT 的疗效尚不清楚。试验序贯分析（TSA）表明，证据不确定，需要进一步的试验才能得出结论。因此，为了获得更高水平的科学证据，继续积累证据至关重要。
