Efficacy of vasopressin, steroid, and epinephrine protocol for in-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

Danish Iltaf Satti; Yan Hiu Athena Lee; Keith Sai Kit Leung; Jeremy Man Ho Hui; Thompson Ka Ming Kot; Arslan Babar; Gauranga Mahalwar; Abraham Kc Wai; Tong Liu; Leonardo Roever; Gary Tse; Jeffrey Shi Kai Chan

doi:10.11909/j.issn.1671-5411.2022.09.002

Efficacy of vasopressin, steroid, and epinephrine protocol for in-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

J Geriatr Cardiol. 2022 Sep 28;19(9):705-711. doi: 10.11909/j.issn.1671-5411.2022.09.002.

Authors

Danish Iltaf Satti¹, Yan Hiu Athena Lee¹, Keith Sai Kit Leung^{1

2

3}, Jeremy Man Ho Hui^{1

4}, Thompson Ka Ming Kot⁵, Arslan Babar⁶, Gauranga Mahalwar⁶, Abraham Kc Wai³, Tong Liu⁷, Leonardo Roever⁸, Gary Tse^{1

7

9}, Jeffrey Shi Kai Chan¹

Affiliations

¹ Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.
² Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
³ Aston Medical School, Faculty of Health & Life Sciences, Aston University, Birmingham, United Kingdom.
⁴ Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
⁵ Department of Anaesthesia and Pain Service, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong, China.
⁶ Department of Medicine, Cleveland Clinic Foundation, Cleveland, USA.
⁷ Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
⁸ Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil.
⁹ Kent and Medway Medical School, Canterbury, Kent, United Kingdom.

PMID: 36284684
PMCID: PMC9548057
DOI: 10.11909/j.issn.1671-5411.2022.09.002

Abstract

Objectives: To assess the effect of vasopressin, steroid and epinephrine (VSE) combination therapy on return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and test the conclusiveness of evidence using trial sequential analysis (TSA).

Methods: The systematic search included PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that included adult patients with IHCA, with at least one group receiving combined VSE therapy were selected. Data was extracted independently by two reviewers. The main outcome of interest was ROSC. Other outcomes included survival to hospital discharge or survival to 30 and 90 days, with good neurological outcomes.

Results: We included a total of three RCTs (n = 869). Results showed that VSE combination therapy increased ROSC (risk ratio = 1.41; 95% CI: 1.25-1.59) as compared to placebo. TSA demonstrated that the existing evidence is conclusive. This was also validated by the alpha-spending adjusted relative risk (1.32 [1.16, 1.49], P < 0.0001). Other outcomes could not be meta-analysed due to differences in timeframe in the included studies.

Conclusions: VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC. Future trials of VSE therapy should evaluate survival to hospital discharge, neurological function and long-term survival.