Comparative effectiveness of vasopressin, steroids, and epinephrine-based regimens in cardiac arrest: A network Meta-analysis of clinical trials

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine Pub Date : 2025-09-23 DOI:10.1016/j.ajem.2025.09.040

Fatemeh Saghafi , Mohammad Hossein Dehghani , Sajjad Erami , Amin Salehi-Abargouei , Mohammad Ali Omrani , Farahnaz Hoseinzade , Maryam Shojaeifard , Adeleh Sahebnasagh

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引用次数: 0

Abstract

Background

Despite extensive efforts to improve survival in cardiac arrest (CA), the optimal pharmacologic strategy during resuscitation remains uncertain. While prior meta-analyses have explored individual drug classes, the relative effectiveness of combined regimens remains inadequately defined. This network meta-analysis (NMA) aims to evaluate and compare the efficacy of triple therapy with vasopressin (VP), steroids, and epinephrine (EP) in CA patients.

Methods

A comprehensive electronic search was conducted in PubMed, Scopus, ISI Web of Science, the Cochrane Central Register of Controlled Trials, Google Scholar, and other bibliographic databases. Randomized clinical trials (RCTs) evaluating the use of steroids, epinephrine, and vasopressin in CA patients were included. In trials that involved additional agents (e.g., lidocaine), only the data pertaining to epinephrine/vasopressor-based interventions were extracted and synthesized to ensure comparability with the study scope. Out of 3453 identified studies, 36 RCTs involving 21,768 patients were included. Interventions during cardiopulmonary resuscitation were categorized as monotherapy, double therapy, or triple therapy (VSE). Primary outcomes included return of spontaneous circulation (ROSC), survival to hospital admission, 24-h survival, and survival to hospital discharge. Neurological outcomes were also evaluated to determine functional recovery, when consistently reported, although heterogeneity of measurement tools precluded quantitative synthesis.

Results

Triple therapy (VSE) and the combination of epinephrine plus steroids demonstrated the highest probability of improving all major survival outcomes. Ranking analysis consistently favored VSE over monotherapies to improve clinical outcomes of CA patients.

Conclusion

This NMA provides comparative evidence supporting the superiority of epinephrine-steroid double therapy and VSE triple therapy in improving resuscitation outcomes in cardiac arrest. These findings may inform future guidelines and clinical decision-making.

Prospero registration

CRD42022296508.

查看原文本刊更多论文

抗利尿激素、类固醇和肾上腺素治疗心脏骤停的比较效果：临床试验的网络荟萃分析。

背景：尽管为提高心脏骤停（CA）患者的生存率做出了广泛的努力，但复苏期间的最佳药物策略仍不确定。虽然先前的荟萃分析已经探索了单个药物类别，但联合治疗方案的相对有效性仍然没有充分定义。该网络荟萃分析（NMA）旨在评估和比较血管加压素（VP）、类固醇和肾上腺素（EP）三联疗法对CA患者的疗效。方法：在PubMed、Scopus、ISI Web of Science、Cochrane Central Register of Controlled Trials、谷歌Scholar等文献数据库中进行全面的电子检索。随机临床试验（rct）评估类固醇、肾上腺素和加压素在CA患者中的应用。在涉及其他药物（如利多卡因）的试验中，仅提取和合成与肾上腺素/血管加压剂干预有关的数据，以确保与研究范围的可比性。在3453项确定的研究中，纳入了36项随机对照试验，涉及21768名患者。心肺复苏期间的干预措施分为单一治疗、双重治疗或三重治疗（VSE）。主要结局包括自发循环恢复（ROSC）、入院生存、24小时生存和出院生存。尽管测量工具的异质性妨碍了定量合成，但在一致报告的情况下，也对神经学结果进行评估以确定功能恢复。结果：三联治疗（VSE）和肾上腺素加类固醇联合治疗显示出改善所有主要生存结局的最高可能性。排名分析一致支持VSE优于单一治疗，以改善CA患者的临床结果。结论：该NMA提供了比较证据，支持肾上腺素-类固醇双重治疗和VSE三联治疗在改善心脏骤停复苏结果方面的优势。这些发现可能为未来的指导方针和临床决策提供信息。普洛斯彼罗注册：CRD42022296508。

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来源期刊

American Journal of Emergency Medicine 医学-急救医学

CiteScore

6.00

自引率

5.60%

发文量

730

审稿时长

42 days

期刊介绍： A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.