Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-06-09 DOI:10.1016/j.jemermed.2025.05.014

Eman E. Shaban , Yavuz Yigit , Ahmed Shaban , Amira Shaban , Mohamed Elgassim , Benny Ponappan , Kaleem Basharat , Hany A. Zaki

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Abstract

Background

The effectiveness of vasopressors in out-of-hospital cardiac arrest (OHCA) remains unclear, despite their widespread use.

Objectives

This meta-analysis investigates the impact of different intravenous (IV) vasopressors on survival rates and neurological function in OHCA patients.

Methods

A comprehensive search was conducted using PubMed, Medline, Embase, and Google Scholar for studies comparing vasopressor efficacy. The analysis included 30 studies with 949,511 OHCA patients. Data on the return of spontaneous circulation (ROSC), survival to hospital admission (SHA), survival to hospital discharge (SHD), 1-month survival, and neurological outcomes were pooled using a random-effects model. The overall effect size was calculated using odds ratios (OR) with 95% confidence intervals (CI).

Results

IV epinephrine improved prehospital ROSC (OR: 2.92, p = 0.0006) and SHA (OR: 1.57, p = 0.01) but did not affect SHD (OR: 0.99, p = 0.96) or 1-month survival (OR: 1.10, p = 0.59). Fewer patients treated with epinephrine achieved favorable neurological outcomes (OR: 0.70, p = 0.005). High-dose epinephrine (HDE) improved ROSC (OR: 1.19, p = 0.003) and SHA (OR: 1.20, p = 0.04) over standard-dose epinephrine (SDE) but not SHD or neurological outcomes. Vasopressin showed moderate benefits over epinephrine for SHA (OR: 0.71, p = 0.03), but epinephrine combined with vasopressin or norepinephrine offered no added benefits.

Conclusion

Epinephrine increases ROSC and SHA in OHCA patients but may worsen neurological outcomes. HDE improves ROSC and SHA over SDE but does not enhance SHD or neurological outcomes. Vasopressin offers moderate benefits, but combinations with other vasopressors do not improve outcomes.

查看原文本刊更多论文

院前心脏骤停静脉血管加压药的疗效和安全性比较：系统回顾和荟萃分析

背景：血管加压药在院外心脏骤停（OHCA）中的有效性尚不清楚，尽管它们被广泛使用。目的：本荟萃分析探讨了不同静脉（IV）血管加压药物对OHCA患者生存率和神经功能的影响。方法：综合检索PubMed、Medline、Embase和谷歌Scholar，比较血管加压药疗效的研究。该分析包括30项研究，949,511名OHCA患者。采用随机效应模型汇总了自发循环恢复（ROSC）、住院生存（SHA）、出院生存（SHD）、1个月生存和神经系统预后的数据。总体效应大小采用比值比（OR）和95%置信区间（CI）计算。结果：静脉注射肾上腺素可改善院前ROSC （OR: 2.92, p = 0.0006）和SHA (OR: 1.57, p = 0.01)，但对SHD （OR: 0.99, p = 0.96）和1个月生存率（OR: 1.10, p = 0.59）无影响。使用肾上腺素治疗的患者较少获得良好的神经预后（OR: 0.70, p = 0.005）。与标准剂量肾上腺素（SDE）相比，高剂量肾上腺素（HDE）改善ROSC （OR: 1.19, p = 0.003）和SHA (OR: 1.20, p = 0.04)，但没有改善SHD或神经系统预后。抗利尿激素比肾上腺素对SHA的疗效中等（OR: 0.71, p = 0.03），但肾上腺素联合抗利尿激素或去甲肾上腺素没有额外的疗效。结论：肾上腺素增加OHCA患者的ROSC和SHA，但可能使神经系统预后恶化。与SDE相比，HDE改善了ROSC和SHA，但没有改善SHD或神经学预后。抗利尿激素提供了适度的益处，但与其他抗利尿激素联合使用并不能改善结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine