Abdelazeem Basel, Awad Ahmed K, Manasrah Nouraldeen, Elbadawy Merihan A, Ahmad Soban, Savarapu Pramod, Abbas Kirellos Said, Kunadi Arvind
McLaren Health Care, Flint, MI, USA.
Michigan State University, East Lansing, MI, USA.
Am J Cardiovasc Drugs. 2022 Sep;22(5):523-533. doi: 10.1007/s40256-022-00522-z. Epub 2022 Mar 22.
Cardiac arrest is often fatal if not treated immediately by cardiopulmonary resuscitation to restore a normal heart rhythm and spontaneous circulation. We aim to evaluate the clinical benefits of vasopressin and methylprednisolone versus placebo for patients with in-hospital cardiac arrest.
We searched PubMed, EMBASE, Scopus, Web of Science, Cochrane Central, and Google Scholar from inception to October 17, 2021, by using search terms included "Vasopressin" AND "Methylprednisolone" AND "Cardiac arrest".
We included randomized controlled trials (RCTs) that compared vasopressin and methylprednisolone to placebo. The main outcomes were the return of spontaneous circulation (ROSC) and survival to hospital discharge.
A total of three RCTs, with a total of 869 patients, were included. The pooled risk ratios (RRs) were calculated along with their 95% confidence intervals (CIs). Our result showed an increase in ROSC in patients who received vasopressin and methylprednisolone (RR = 1.32; 95% CI = [1.18, 1.47], p < 0.00001) when compared with the placebo group. However, there was no difference between both groups regarding survival to hospital discharge (RR = 1.76; 95% CI = [0.68, 4.56], p= 0.25).
The current guidelines recommend epinephrine for patients with in-hospital cardiac arrest. Our meta-analysis updates clinicians about using vasopressin and methylprednisolone besides epinephrine, providing them with the best available evidence in managing patients with in-hospital cardiac arrest.
Among patients with in-hospital cardiac arrest, administration of vasopressin and methylprednisolone besides epinephrine is associated with increased ROSC compared with placebo and epinephrine. However, high-quality RCTs are necessary before drawing a firm conclusion regarding the efficacy of vasopressin and methylprednisolone for patients with in-hospital cardiac arrest.
心脏骤停若不立即通过心肺复苏进行治疗以恢复正常心律和自主循环，通常会导致死亡。我们旨在评估血管加压素和甲泼尼龙与安慰剂相比，对院内心脏骤停患者的临床益处。
我们检索了PubMed、EMBASE、Scopus、Web of Science、Cochrane Central和Google Scholar，检索时间从数据库建立至2021年10月17日，检索词包括“血管加压素”“甲泼尼龙”和“心脏骤停”。
我们纳入了比较血管加压素和甲泼尼龙与安慰剂的随机对照试验（RCT）。主要结局是自主循环恢复（ROSC）和存活至出院。
共纳入三项RCT，总计869例患者。计算了合并风险比（RR）及其95%置信区间（CI）。我们的结果显示，与安慰剂组相比，接受血管加压素和甲泼尼龙的患者ROSC增加（RR = 1.32；95%CI = [1.18, 1.47]，p < 0.00001）。然而，两组在存活至出院方面无差异（RR = 1.76；95%CI = [0.68, 4.56]，p = 0.25）。
当前指南推荐对院内心脏骤停患者使用肾上腺素。我们的荟萃分析向临床医生更新了除肾上腺素外使用血管加压素和甲泼尼龙的情况，为他们管理院内心脏骤停患者提供了最佳现有证据。
在院内心脏骤停患者中，除肾上腺素外使用血管加压素和甲泼尼龙与安慰剂和肾上腺素相比，ROSC增加。然而，在就血管加压素和甲泼尼龙对院内心脏骤停患者的疗效得出确凿结论之前，还需要高质量的RCT。
