成人心肺复苏期间使用皮质类固醇的临床益处：一项系统评价和荟萃分析。

Clinical benefits of corticosteroid administration during adult cardiopulmonary resuscitation: A systemic review and meta-analysis.

作者信息

Wongtanasarasin Wachira, Krintratun Sarunsorn

机构信息

Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.

出版信息

World J Crit Care Med. 2021 Sep 9;10(5):290-300. doi: 10.5492/wjccm.v10.i5.290.

DOI:10.5492/wjccm.v10.i5.290

PMID:34616663

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8462020/

Abstract

BACKGROUND

The clinical benefits of steroid administration during cardiac arrest remain unclear. Several studies reported that patients who received steroids after achieving a return of spontaneous circulation (ROSC) had better outcomes, but few studies have investigated the benefits of steroid administration during resuscitation. We hypothesized that administration of steroid during cardiac arrest would be associated with better clinical outcomes in adults with cardiac arrest.

AIM

To investigate the effect of steroid administration during cardiac arrest and the outcomes of resuscitation.

METHODS

We included studies of participants older than 18 years of age who experienced cardiac arrest and included at least one arm that received corticosteroids during cardiac arrest. A literature search of PubMed and Embase on 31 January 2021 retrieved placebo-controlled studies without limitation for type, location, and initial presenting rhythm of cardiac arrest. The study outcomes were reported by odds ratios (ORs) compared with placebo. The primary outcome was survival rate at hospital discharge. Secondary outcomes included a sustained ROSC, survival rate at hospital admission, and neurological outcome at hospital discharge.

RESULTS

Six studies including 146262 participants were selected for analysis. The risk of bias ranged from low to high for randomized-controlled trials (RCTs) and low (for non-RCTs). Steroid administration was associated with increased survival at hospital discharge [OR: 3.51, 95% confidence interval (CI): 1.98-6.20, < 0.001], and steroid administration during cardiac arrest was associated with both an increased rate of sustained ROSC (OR: 1.81, 95%CI: 1.91-4.02, < 0.001) and a favorable neurological outcome at hospital discharge (OR: 3.02, 95%CI: 1.26-7.24, = 0.01).

CONCLUSION

Steroid administration during cardiac arrest was associated with better outcomes of resuscitation. Further study of the use of steroid in the selected circumstances are warranted.

摘要

背景

心脏骤停期间使用类固醇的临床益处尚不清楚。几项研究报告称，在恢复自主循环（ROSC）后接受类固醇治疗的患者预后较好，但很少有研究探讨复苏期间使用类固醇的益处。我们假设，心脏骤停期间给予类固醇与成年心脏骤停患者更好的临床结局相关。

目的

研究心脏骤停期间给予类固醇的效果及复苏结局。

方法

我们纳入了年龄大于18岁且经历心脏骤停的参与者的研究，且至少有一组在心脏骤停期间接受了皮质类固醇治疗。2021年1月31日在PubMed和Embase上进行的文献检索检索到了安慰剂对照研究，对心脏骤停的类型、位置和初始表现节律没有限制。研究结果通过与安慰剂相比的优势比（OR）报告。主要结局是出院时的生存率。次要结局包括持续ROSC、入院时的生存率和出院时的神经学结局。

结果

选择了6项研究，共146262名参与者进行分析。随机对照试验（RCT）的偏倚风险从低到高，非RCT的偏倚风险为低。给予类固醇与出院时生存率增加相关[OR：3.51，95%置信区间（CI）：1.98 - 6.20，P < 0.001]，心脏骤停期间给予类固醇与持续ROSC率增加（OR：1.81，95%CI：1.91 - 4.02，P < 0.001）和出院时良好的神经学结局（OR：3.02，95%CI：1.26 - 7.24，P = 0.01）均相关。