Zhang Han, Liu Feng, Lu Xueli
Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, Henan Province, China.
Department of Intensive Care Unit, Huaihe Hospital of Henan University, Kaifeng, Henan Province, China.
Medicine (Baltimore). 2025 Mar 7;104(10):e41698. doi: 10.1097/MD.0000000000041698.
This study aimed to compare the effectiveness of various treatments for out-of-hospital cardiac arrest (OHCA) patients using a network meta-analysis.
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.
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.
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.
本研究旨在通过网络荟萃分析比较院外心脏骤停（OHCA）患者各种治疗方法的有效性。
对PubMed、Embase和Cochrane图书馆数据库从创建至2024年1月进行系统检索，以确定比较各种治疗方法（肾上腺素（高剂量）、血管加压素、肾上腺素（标准剂量）、肾上腺素 + 血管加压素）或安慰剂用于OHCA患者的随机对照试验。进行贝叶斯网络荟萃分析，并使用带有gemtc包的R软件进行数据提取和分析。根据累积排序曲线下面积（SUCRA）值对治疗方案进行排序。
最终，本网络荟萃分析共纳入18项研究（21,594例患者）。与安慰剂相比，肾上腺素（高剂量）、血管加压素、肾上腺素（标准剂量）、肾上腺素 + 血管加压素均提高了自主循环恢复（ROSC）率，差异具有统计学意义（P <.05）。肾上腺素（高剂量）的ROSC率排名第一（SUCRA，85.0%）。与安慰剂相比，肾上腺素（高剂量）、血管加压素、肾上腺素（标准剂量）、肾上腺素 + 血管加压素均提高了出院生存率，差异具有统计学意义（P <.05）。在功能结局良好的生存率方面，肾上腺素（高剂量）、血管加压素、肾上腺素（标准剂量）、肾上腺素 + 血管加压素与安慰剂之间无显著差异。
与安慰剂相比，标准剂量肾上腺素、高剂量肾上腺素、肾上腺素联合血管加压素以及单独使用血管加压素用于OHCA已被证明可提高ROSC率以及入院和出院生存率，但不能改善良好的功能结局。
