Aim

To perform a systematic review and individual participant data meta-analysis of vasopressin and glucocorticoids for the treatment of cardiac arrest.

Methods

The PRISMA-IPD guidelines were followed. We searched Medline, Embase, and the Cochrane Library for randomized trials comparing vasopressin and glucocorticoids to placebo during cardiac arrest. The population included adults with cardiac arrest in any setting. Pairs of investigators reviewed studies for relevance, extracted data, and assessed risk of bias. Meta-analyses were conducted using individual participant data. A Bayesian framework was used to estimate posterior treatment effects assuming various prior beliefs. The certainty of evidence was evaluated using GRADE.

Results

Three trials were identified including adult in-hospital cardiac arrests only. Individual participant data were obtained from all trials yielding a total of 869 patients. There was some heterogeneity in post-cardiac arrest interventions between the trials. The results favored vasopressin and glucocorticoids for return of spontaneous circulation (odds ratio: 2.09, 95%CI: 1.54 to 2.84, moderate certainty). Estimates for survival at discharge (odds ratio: 1.39, 95%CI: 0.90 to 2.14, low certainty) and favorable neurological outcome (odds ratio: 1.64, 95%CI, 0.99 to 2.72, low certainty) were more uncertain. The Bayesian estimates for return of spontaneous circulation were consistent with the primary analyses, whereas the estimates for survival at discharge and favorable neurological outcome were more dependent on the prior belief.

Conclusions

Among adults with in-hospital cardiac arrest, vasopressin and glucocorticoids compared to placebo, improved return of spontaneous circulation. Larger trials are needed to determine whether there is an effect on longer-term outcomes.

中文翻译：

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加压素和糖皮质激素治疗院内心脏骤停：个体参与者数据的系统回顾和荟萃分析

目的

对加压素和糖皮质激素治疗心脏骤停进行系统评价和个体参与者数据荟萃分析。

方法

遵循 PRISMA-IPD 指南。我们检索了 Medline、Embase 和 Cochrane 图书馆，查找在心脏骤停期间比较加压素和糖皮质激素与安慰剂的随机试验。人群包括在任何情况下发生心脏骤停的成年人。成对的研究人员审查了研究的相关性、提取数据并评估偏倚风险。使用个体参与者数据进行荟萃分析。贝叶斯框架用于估计假设各种先验信念的后验治疗效果。使用 GRADE 评估证据的质量。

结果

确定的三项试验仅包括成人院内心脏骤停。个体参与者数据来自总共 869 名患者的所有试验。各项试验之间的心脏骤停后干预措施存在一些异质性。结果有利于加压素和糖皮质激素恢复自主循环（比值比：2.09，95%CI：1.54 至 2.84，中等确定性）。出院时生存率（比值比：1.39，95% CI：0.90 至 2.14，低确定性）和良好的神经学结果（比值比：1.64，95% CI，0.99 至 2.72，低确定性）的估计更加不确定。对自发循环恢复的贝叶斯估计与主要分析一致，而对出院时生存和良好神经学结果的估计则更依赖于先前的信念。

结论

在患有院内心脏骤停的成人中，与安慰剂相比，加压素和糖皮质激素改善了自主循环的恢复。需要更大规模的试验来确定是否对长期结果有影响。