Department of Medicine, Division of Critical Care, Juravinski Hospital, McMaster University, 711 Concession St, Hamilton, ON, L8V 1C1, Canada.
Department of Critical Care Medicine, Queen's University, Kingston, Canada.
Crit Care. 2023 Jan 11;27(1):12. doi: 10.1186/s13054-022-04297-2.
Post-cardiac arrest, outcomes for most patients are poor, regardless of setting. Many patients who do achieve spontaneous return of circulation require vasopressor therapy to maintain organ perfusion. There is some evidence to support the use of corticosteroids in cardiac arrest.
Assess the efficacy and safety of corticosteroids in patients following in- and out-of-hospital cardiac arrest.
We searched databases CINAHL, EMBASE, LILACS, MEDLINE, Web of Science, CENTRAL, ClinicalTrails.gov, and ICTRP. We included randomized controlled trials (RCTs) that examined the efficacy and safety of corticosteroids, as compared to placebo or usual care in patients post-cardiac arrest. We pooled estimates of effect size using random effects meta-analysis and report relative risk (RR) with 95% confidence intervals (CIs). We assessed risk of bias (ROB) for the included trials using the modified Cochrane ROB tool and rated the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation methodology.
We included 8 RCTs (n = 2213 patients). Corticosteroids administered post-cardiac arrest had an uncertain effect on mortality measured at the longest point of follow-up (RR 0.96, 95% CI 0.90-1.02, very low certainty, required information size not met using trial sequential analysis). Corticosteroids probably increase return of spontaneous circulation (ROSC) (RR 1.32, 95% CI 1.18-1.47, moderate certainty) and may increase the likelihood of survival with good functional outcome (RR 1.49, 95% CI 0.87-2.54, low certainty). Corticosteroids may decrease the risk of ventilator associated pneumonia (RR 0.76, 95% CI 0.46-1.09, low certainty), may increase renal failure (RR 1.29, 95% CI 0.84-1.99, low certainty), and have an uncertain effect on bleeding (RR 2.04, 95% CI 0.53-7.84, very low certainty) and peritonitis (RR 10.54, 95% CI 2.99-37.19, very low certainty).
In patients during or after cardiac arrest, corticosteroids have an uncertain effect on mortality but probably increase ROSC and may increase the likelihood of survival with good functional outcome at hospital discharge. Corticosteroids may decrease ventilator associated pneumonia, may increase renal failure, and have an uncertain effect on bleeding and peritonitis. However, the pooled evidence examining these outcomes was sparse and imprecision contributed to low or very low certainty of evidence.
无论在院内还是院外发生心脏骤停后，大多数患者的预后都很差。许多自主循环恢复的患者需要升压治疗来维持器官灌注。有一些证据支持在心脏骤停中使用皮质类固醇。
评估皮质类固醇在院内和院外心脏骤停后患者中的疗效和安全性。
我们检索了 CINAHL、EMBASE、LILACS、MEDLINE、Web of Science、CENTRAL、ClinicalTrials.gov 和 ICTRP 数据库。我们纳入了比较皮质类固醇与安慰剂或常规治疗在心脏骤停后患者中的疗效和安全性的随机对照试验（RCT）。我们使用随机效应荟萃分析汇总效应大小的估计值，并报告相对风险（RR）及其 95%置信区间（CI）。我们使用改良 Cochrane 偏倚风险工具评估纳入试验的偏倚风险（ROB），并使用 Grading of Recommendations Assessment, Development and Evaluation 方法评估证据的确定性。
我们纳入了 8 项 RCT（n=2213 名患者）。心脏骤停后给予皮质类固醇对最长随访时间点的死亡率影响不确定（RR 0.96，95%CI 0.90-1.02，极低确定性，使用试验序贯分析需要更多信息）。皮质类固醇可能增加自主循环恢复（ROSC）（RR 1.32，95%CI 1.18-1.47，中等确定性），并可能增加出院时存活且功能良好的可能性（RR 1.49，95%CI 0.87-2.54，低确定性）。皮质类固醇可能降低呼吸机相关性肺炎的风险（RR 0.76，95%CI 0.46-1.09，低确定性），可能增加肾衰竭的风险（RR 1.29，95%CI 0.84-1.99，低确定性），对出血（RR 2.04，95%CI 0.53-7.84，极低确定性）和腹膜炎（RR 10.54，95%CI 2.99-37.19，极低确定性）的影响不确定。
在心脏骤停期间或之后的患者中，皮质类固醇对死亡率的影响不确定，但可能增加 ROSC，并可能增加出院时存活且功能良好的可能性。皮质类固醇可能降低呼吸机相关性肺炎的风险，可能增加肾衰竭的风险，对出血和腹膜炎的影响不确定。然而，评估这些结局的汇总证据很少，不精确性导致证据的确定性为低或极低。
