Efficacy of combination triple therapy with vasopressin, steroid, and epinephrine in cardiac arrest: a systematic review and meta-analysis of randomized-controlled trials

Abstract

Background 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). Materials and methods Various databases were explored from inception until October 2021 for relevant published clinical trials and cohort studies. Results Three 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). Conclusions VSE 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).

Therapeutic effects of vasopressin on cardiac arrest: a systematic review and meta-analysis

“…A difference between our study and those two recent studies29 30 by Granfeldt et al and Saghafi et al is that we evaluated the overall impact of vasopressin in cardiac arrest. There is no single optimal method suitable for all patients.…”

“…The conclusion coincides with the results from our study. Moreover, a meta-analysis by Saghafi et al 30 suggested that VSE combination therapy during and after IHCA may have beneficial effects in terms of the ROSC, Open access renal and circulatory failure free days, and mean arterial pressure. In our study, three trials [12][13][14] receiving VSE were included, and three trials used the same VSE protocol during CPR, as shown in table 2.…”

Mortality, morbidity & clinical outcome with different types of vasopressors in out of hospital cardiac arrest patients- a systematic review and meta-analysis

“…For instance, 0.5 mg to more than 10 mg epinephrine has been administered through intravenous, intracardiac, endobronchial, and intraosseous routes [6]. Epinephrine is an active sympathomimetic hormone that stimulates the alpha-(α) and beta (β)-adrenergic systems during cardiopulmonary resuscitation [7], thus increasing the probability of achieving return of spontaneous circulation (ROSC). According to previous studies, stimulation of the alpha (α) receptor on the vascular smooth muscles leads to vasoconstriction, which increases aortic diastolic and perfusion pressure to optimize the probability of attaining ROSC [8].…”

Удк 616.12-008.313.315+577.17 Doi: 10.55359/2782-3296.2022.25.35.008 Тройная Комбинированная Терапия (Вазопрессин, Адреналин, Стероиды) И Новые Техники Сердчено-Легочной Реанимации (Обзор Литературы)

“…У выживших после остановки сердца тяжелые церебральные нарушения встречаются в 25-50% случаев [18]. В исследовании Andersen et al неврологический статус измерялся по шкале CPC, благоприятный неврологический исход наблюдался у 7,6% пациентов как в группе вмешательства, так и в контрольной группе во время первого цикла СЛР, на 30-й день без существенной разницы между двумя группами исследования (значение p> 0,99) [19]. Неврологически благоприятная выживаемость до выписки из больницы оценивалась в исследовании Mentzelopoulos et al, где неврологическая недостаточность определялась по шкале комы Глазго (ШКГ) <9 баллов.…”