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  • 100 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

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Cardiac rhythm management
100 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
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  1. Danish Iltaf Satti1,
  2. Yan Hiu Athena Lee2,
  3. Keith Sai Kit Leung2,
  4. Jeremy Man Ho Hui2,
  5. Thompson Ka Ming Kot2,
  6. Arslan Babar2,
  7. Gauranga Mahalwar2,
  8. Abraham KC Wai2,
  9. Tong Liu2,
  10. Leonardo Roever2,
  11. Gary Tse2,
  12. Jeffrey Shi Kai Chan2
  1. 1Cardiovascular Analytics Group, Hong Kong China-UK collaboration, NCBMS Tower, Sector H-8/4service road S, near Federal Board Offic, Islamabad, 46000, Pakistan
  2. 2Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration

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 patients). 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.

Abstract 100 Figure 1
Abstract 100 Figure 1
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Conclusion 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.

Conflict of Interest None

  • cardiac arrest
  • cardiopulmonary resuscitation
  • vasopressin

https://doi.org/10.1136/heartjnl-2022-BCS.100

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