Comparison of different treatments of out-of-hospital cardiac arrest: A systematic review and network meta-analysis.

BACKGROUND

This study aimed to compare the effectiveness of various treatments for out-of-hospital cardiac arrest (OHCA) patients using a network meta-analysis.

METHODS

A systematic search was conducted on Pubmed, Embase, and Cochrane Library databases from their inception to January 2024 to identify randomized controlled trials comparing various treatments (epinephrine (high dose), vasopressin, epinephrine (standard dose), epinephrine + vasopressin) or placebo for OHCA patients. Bayesian network meta-analyses were performed, and data extraction and analysis were carried out using the R software with the gemtc package. The treatment options were ranked based on the surface under the cumulative ranking curve (SUCRA) value.

RESULTS

Finally, a total of 18 studies (21,594 patients) were included in this network meta-analysis. Compared with placebo, epinephrine (high dose), vasopressin, epinephrine (standard dose), epinephrine + vasopressin all increase the return of spontaneous circulation (ROSC) rate, and the difference was statistically significant (P < .05). Epinephrine (high dose) ranked first (SUCRA, 85.0%) for ROSC rate. Compared with placebo, epinephrine (high dos), vasopressin, epinephrine (standard dose), epinephrine + vasopressin all increase the ROSC rate, and the difference was statistically significant (P < .05). The SUCRA shows that vasopressin ranked first (SUCRA, 79.3%). Compared with placebo, epinephrine (high dose), vasopressin, epinephrine (standard dos), epinephrine + vasopressin all increase the survival to discharge, and the difference was statistically significant (P < .05). There was no significant difference between epinephrine (high dose), vasopressin, epinephrine (standard dos), epinephrine + vasopressin with placebo for survival with good functional outcome.

CONCLUSIONS

Compared to placebo, standard-dose epinephrine, high-dose epinephrine, epinephrine combined with vasopressin, and vasopressin alone for OHCA have been shown to improve rates of ROSC and survival to hospital admission and discharge, but do not improve favorable functional outcomes.