Satti Danish Iltaf, Lee Yan Hiu Athena, Leung Keith Sai Kit, Hui Jeremy Man Ho, Kot Thompson Ka Ming, Babar Arslan, Mahalwar Gauranga, Wai Abraham Kc, Liu Tong, Roever Leonardo, Tse Gary, Chan Jeffrey Shi Kai
Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.
Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
J Geriatr Cardiol. 2022 Sep 28;19(9):705-711. doi: 10.11909/j.issn.1671-5411.2022.09.002.
To assess the effect of vasopressin, steroid and epinephrine (VSE) combination therapy on return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and test the conclusiveness of evidence using trial sequential analysis (TSA).
The systematic search included PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that included adult patients with IHCA, with at least one group receiving combined VSE therapy were selected. Data was extracted independently by two reviewers. The main outcome of interest was ROSC. Other outcomes included survival to hospital discharge or survival to 30 and 90 days, with good neurological outcomes.
We included a total of three RCTs ( = 869). Results showed that VSE combination therapy increased ROSC (risk ratio = 1.41; 95% CI: 1.25-1.59) as compared to placebo. TSA demonstrated that the existing evidence is conclusive. This was also validated by the alpha-spending adjusted relative risk (1.32 [1.16, 1.49], < 0.0001). Other outcomes could not be meta-analysed due to differences in timeframe in the included studies.
VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC. Future trials of VSE therapy should evaluate survival to hospital discharge, neurological function and long-term survival.
评估血管加压素、类固醇和肾上腺素（VSE）联合治疗对院内心脏骤停（IHCA）后自主循环恢复（ROSC）的影响，并使用序贯试验分析（TSA）检验证据的确定性。
系统检索包括PubMed、EMBASE、Scopus和Cochrane对照试验中央注册库。选择纳入成年IHCA患者的随机对照试验（RCT），其中至少有一组接受VSE联合治疗。由两名研究者独立提取数据。主要关注的结局是ROSC。其他结局包括出院存活或30天和90天存活且神经功能良好。
我们共纳入三项RCT（n = 869）。结果显示，与安慰剂相比，VSE联合治疗可提高ROSC（风险比 = 1.41；95% CI：1.25 - 1.59）。TSA表明现有证据具有确定性。这也通过α消耗调整相对风险得到验证（1.32 [1.16, 1.49]，P < 0.0001）。由于纳入研究的时间框架不同，其他结局无法进行荟萃分析。
心肺复苏中应用VSE联合治疗可提高ROSC率。未来VSE治疗试验应评估出院存活率、神经功能和长期存活率。
