Efficacy of vasopressin during cardio-pulmonary resuscitation in adult patients: A meta-analysis

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• 作者：Amitava Layek^a ; Souvik Maitra^b ; Sugata Pal^c ; Sulagna Bhattacharjee^b ; ^{bhattacharjee.sulagna85@gmail.com" class="auth_mail} ; Dalim K. Baidya^d
• 关键词：ACLS ; advanced cardiac life support ; CPR ; cardio-pulmonary resuscitation ; RCT ; randomized controlled trial ; ROSC ; return of spontaneous circulation ; OR ; odd's ratio ; CI ; confidence interval ; ACC/AHA ; American College of Cardiology/American Heart Association ; PRISMA ; Preferred Reporting Items for Systematic Reviews and Meta-analyses ; SD ; standard deviation ; NNT ; number needed to treat ; VF ; ventricular fibrillation ; VT ; ventricular tachycardia ; PEA ; pulse less electrical activity
• 刊名：Resuscitation
• 出版年：July 2014
• 年：2014
• 卷：85
• 期：7
• 页码：855-863
• 全文大小：2619 K

文摘

Experimental and animal studies suggested that vasopressin may have a favorable survival profile during CPR. This meta-analysis aimed to determine the efficacy of vasopressin in adult cardiac patients.

Methodology

Meta-analysis of randomized control trials (RCTs) comparing the efficacy of vasopressin containing regimen during CPR in adult cardiac arrest population with an epinephrine only regimen.

Results

A total of 6120 patients from 10 RCTs were included in this meta-analysis. Vasopressin use during CPR has no beneficial impact in an unselected population in ROSC [OR 1.19, 95% CI 0.93, 1.52], survival to hospital discharge [OR 1.13, 95% CI 0.89, 1.43], survival to hospital admission [OR 1.12, 95% CI 0.99, 1.27] and favorable neurological outcome [OR 1.02, 95% CI 0.75, 1.38]. ROSC in “in-hospital” cardiac arrest setting [OR 2.20, 95% CI 1.08, 4.47] is higher patients receiving vasopressin. Subgroup analyses revealed equal or higher chance of ROSC [OR 2.15, 95% CI 1.00, 4.61], higher possibility of survival to hospital discharge [OR 2.39, 95% CI 1.34, 4.27] and favorable neurological outcome [OR 2.58, 95% CI 1.39, 4.79] when vasopressin was used as repeated boluses of 4–5 times titrating desired effects during CPR.

Conclusion

ROSC in “in-hospital” cardiac arrest patients is significantly better when vasopressin was used. A subgroup analysis of this meta-analysis found that ROSC, survival to hospital admission and discharge and favorable neurological outcome may be better when vasopressin was used as repeated boluses of 4–5 times titrated to desired effects; however, overall no beneficial effect was noted in unselected cardiac arrest population.