Pyo Youngchan, Chung Tae Nyoung
Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Clin Exp Emerg Med. 2022 Dec;9(4):286-295. doi: 10.15441/ceem.22.371. Epub 2022 Oct 14.
Corticosteroids may have a beneficial effect on the outcome of cardiac arrest (CA); however, it is not known whether the timing of corticosteroid use affects the outcome. We performed a systematic review and network meta-analysis to compare the efficacy of corticosteroid administration according to the timing. A favorable final outcome, as the primary study outcome, was defined as a combination of survival with good neurologic outcome and survival for 1 year. The secondary outcome was survival to discharge. Nine clinical studies were included. Corticosteroids administered during cardiopulmonary resuscitation (CPR; odds ratio [OR], 1.29; 95% confidence interval [CI], 1.11-1.51) and post-CA (OR, 1.47; 95% CI, 1.30-1.66) had a positive effect on the favorable final outcome compared to the control protocol (no corticosteroid administration), while those used prior to CA had a negative effect. Corticosteroids administered post-CA had a positive effect on survival to discharge compared to the control protocol (OR, 1.82; 95% CI, 1.02-3.27), while those used prior to CA and during CPR had no significant effect. Post-CA was evaluated to be the best administration timing for both outcomes. In conclusion, the timing of corticosteroid administration may be an important factor for the prognosis of CA. Corticosteroids administration post-CA and during CPR may have beneficial effects on CA outcomes.
皮质类固醇可能对心脏骤停（CA）的预后有有益影响；然而，尚不清楚使用皮质类固醇的时机是否会影响预后。我们进行了一项系统评价和网状Meta分析，以比较根据不同时机给予皮质类固醇的疗效。将良好的最终预后作为主要研究结局，定义为存活且神经功能良好和存活1年的综合情况。次要结局是存活至出院。纳入了9项临床研究。与对照方案（不给予皮质类固醇）相比，在心肺复苏（CPR）期间给予皮质类固醇（优势比[OR]，1.29；95%置信区间[CI]，1.11 - 1.51）和心脏骤停后给予皮质类固醇（OR，1.47；95%CI，1.30 - 1.66）对良好的最终预后有积极影响，而在心脏骤停前使用则有负面影响。与对照方案相比，心脏骤停后给予皮质类固醇对存活至出院有积极影响（OR，1.82；95%CI，1.02 - 3.27），而在心脏骤停前和心肺复苏期间使用则无显著影响。心脏骤停后被评估为这两个结局的最佳给药时机。总之，皮质类固醇的给药时机可能是心脏骤停预后的一个重要因素。心脏骤停后和心肺复苏期间给予皮质类固醇可能对心脏骤停的结局有有益影响。
