Abstract
BackgroundThis study investigated whether combination therapy with vasopressin, steroid, and epinephrine (VSE) improves in-hospital survival and return of spontaneous circulation (ROSC) during and after resuscitation in-hospital cardiac arrest (CA).Materials and methodsVarious databases were explored from inception until October 2021 for relevant published clinical trials and cohort studies.ResultsThree clinical trials were included. Pooled analysis suggested that VSE was significantly associated with increased ROSC in patients with in-hospital CA (IHCA) (odds ratio (OR): 2.281, 95% confidence interval (CI): 1.304–3.989, P value = 0.004). Meta-analysis of two studies (368 patients) demonstrated a significant difference in the reduction of mean arterial pressure (MAP) during and 15–20 min after cardiopulmonary resuscitation (standardized mean difference (SMD): 1.069, 95% CI: 0.851–1.288, P value < 0.001), renal failure free days (SMD = 0.590; 95% CI: 0.312–0.869 days; P value < 0.001), and coagulation failure free days (SMD = 0.403; 95% CI: 0.128–0.679, P value = 0.004). However, no significant difference was observed for survival-to-discharge ratio (OR: 2.082, 95% CI: 0.638–6.796, P value = 0.225) and ventilator free days (SMD = 0.201, 95% CI: − 0.677, 1.079 days; P value = 0.838).ConclusionsVSE combination therapy during and after IHCA may have beneficial effects in terms of the ROSC, renal and circulatory failure free days, and MAP.Prospero registration: CRD42020178297 (05/07/2020).
Highlights
This study investigated whether combination therapy with vasopressin, steroid, and epinephrine (VSE) improves in-hospital survival and return of spontaneous circulation (ROSC) during and after resuscitation in-hospital cardiac arrest (CA)
MEDLINE in PubMed, Scopus, ISI Web of Science, Cochrane central register for controlled trials and Google Scholar databases were searched for the following keywords: “Hydrocortisone” observed for survival-to-discharge ratio (OR) “Steroid” OR “Glucocorticoids” OR “Methylprednisolone” in combination with “Epinephrine” OR “Adrenaline” OR “EP” in combination with “Vasopressin” OR “Antidiuretic Hormones” in combination with “Cardiac Arrest” OR “Heart Arrest” OR “Sudden Cardiac Death” (Search strategy is presented in Additional file 1: Appendix A)
A total of three Randomized clinical trial (RCT) were eligible for including in the current systematic review and meta-analysis, carried out on 869 subjects [26,27,28]
Summary
This study investigated whether combination therapy with vasopressin, steroid, and epinephrine (VSE) improves in-hospital survival and return of spontaneous circulation (ROSC) during and after resuscitation in-hospital cardiac arrest (CA). Cardiac arrest (CA) is referred to as sudden loss of blood flow resulting from heart struggle to effectively pump blood to the brain and other vital organs [1]. Some physiological events, such as intense sympathetic stimulation and subsequent vasoconstriction, and the increased heart rate and respiratory drive occur that. The advanced cardiac life support (ACLS) guidelines recommend initiation of adult basic life support (BLS) algorithm and high-quality cardiopulmonary resuscitation (CPR). If the second defibrillation fails, antiarrhythmic drugs of amiodarone or lidocaine should be initiated [3]
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