Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials
Abstract Background Post-cardiac arrest, outcomes for most patients are poor, regardless of setting. Many patients who do achieve spontaneous return of circulation require vasopressor therapy to maintain organ perfusion. There is some evidence to support the use of corticosteroids in cardiac arrest....
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-022-04297-2 |
| _version_ | 1797952481700872192 |
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| author | Jeremy Penn Will Douglas Jeffrey Curran Dipayan Chaudhuri Joanna C. Dionne Shannon M. Fernando David Granton Rebecca Mathew Bram Rochwerg |
| author_facet | Jeremy Penn Will Douglas Jeffrey Curran Dipayan Chaudhuri Joanna C. Dionne Shannon M. Fernando David Granton Rebecca Mathew Bram Rochwerg |
| author_sort | Jeremy Penn |
| collection | DOAJ |
| description | Abstract Background Post-cardiac arrest, outcomes for most patients are poor, regardless of setting. Many patients who do achieve spontaneous return of circulation require vasopressor therapy to maintain organ perfusion. There is some evidence to support the use of corticosteroids in cardiac arrest. Research question Assess the efficacy and safety of corticosteroids in patients following in- and out-of-hospital cardiac arrest. Study design and methods We searched databases CINAHL, EMBASE, LILACS, MEDLINE, Web of Science, CENTRAL, ClinicalTrails.gov, and ICTRP. We included randomized controlled trials (RCTs) that examined the efficacy and safety of corticosteroids, as compared to placebo or usual care in patients post-cardiac arrest. We pooled estimates of effect size using random effects meta-analysis and report relative risk (RR) with 95% confidence intervals (CIs). We assessed risk of bias (ROB) for the included trials using the modified Cochrane ROB tool and rated the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation methodology. Results We included 8 RCTs (n = 2213 patients). Corticosteroids administered post-cardiac arrest had an uncertain effect on mortality measured at the longest point of follow-up (RR 0.96, 95% CI 0.90–1.02, very low certainty, required information size not met using trial sequential analysis). Corticosteroids probably increase return of spontaneous circulation (ROSC) (RR 1.32, 95% CI 1.18–1.47, moderate certainty) and may increase the likelihood of survival with good functional outcome (RR 1.49, 95% CI 0.87–2.54, low certainty). Corticosteroids may decrease the risk of ventilator associated pneumonia (RR 0.76, 95% CI 0.46–1.09, low certainty), may increase renal failure (RR 1.29, 95% CI 0.84–1.99, low certainty), and have an uncertain effect on bleeding (RR 2.04, 95% CI 0.53–7.84, very low certainty) and peritonitis (RR 10.54, 95% CI 2.99–37.19, very low certainty). Conclusions In patients during or after cardiac arrest, corticosteroids have an uncertain effect on mortality but probably increase ROSC and may increase the likelihood of survival with good functional outcome at hospital discharge. Corticosteroids may decrease ventilator associated pneumonia, may increase renal failure, and have an uncertain effect on bleeding and peritonitis. However, the pooled evidence examining these outcomes was sparse and imprecision contributed to low or very low certainty of evidence. |
| first_indexed | 2024-04-10T22:48:08Z |
| format | Article |
| id | doaj.art-5f202e9f87034cfb8fdf1fa455dbcbc0 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-10T22:48:08Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-5f202e9f87034cfb8fdf1fa455dbcbc02023-01-15T12:13:22ZengBMCCritical Care1364-85352023-01-0127111110.1186/s13054-022-04297-2Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trialsJeremy Penn0Will Douglas1Jeffrey Curran2Dipayan Chaudhuri3Joanna C. Dionne4Shannon M. Fernando5David Granton6Rebecca Mathew7Bram Rochwerg8Department of Medicine, Division of Critical Care, Juravinski Hospital, McMaster UniversityDepartment of Medicine, Division of Critical Care, Juravinski Hospital, McMaster UniversityDepartment of Critical Care Medicine, Queen’s UniversityDepartment of Medicine, Division of Critical Care, Juravinski Hospital, McMaster UniversityDepartment of Medicine, Division of Critical Care, Juravinski Hospital, McMaster UniversityDivision of Critical Care, Department of Medicine, University of OttawaDepartment of Medicine, University of TorontoDivision of Cardiology, Department of Medicine, University of Ottawa Heart InstituteDepartment of Medicine, Division of Critical Care, Juravinski Hospital, McMaster UniversityAbstract Background Post-cardiac arrest, outcomes for most patients are poor, regardless of setting. Many patients who do achieve spontaneous return of circulation require vasopressor therapy to maintain organ perfusion. There is some evidence to support the use of corticosteroids in cardiac arrest. Research question Assess the efficacy and safety of corticosteroids in patients following in- and out-of-hospital cardiac arrest. Study design and methods We searched databases CINAHL, EMBASE, LILACS, MEDLINE, Web of Science, CENTRAL, ClinicalTrails.gov, and ICTRP. We included randomized controlled trials (RCTs) that examined the efficacy and safety of corticosteroids, as compared to placebo or usual care in patients post-cardiac arrest. We pooled estimates of effect size using random effects meta-analysis and report relative risk (RR) with 95% confidence intervals (CIs). We assessed risk of bias (ROB) for the included trials using the modified Cochrane ROB tool and rated the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation methodology. Results We included 8 RCTs (n = 2213 patients). Corticosteroids administered post-cardiac arrest had an uncertain effect on mortality measured at the longest point of follow-up (RR 0.96, 95% CI 0.90–1.02, very low certainty, required information size not met using trial sequential analysis). Corticosteroids probably increase return of spontaneous circulation (ROSC) (RR 1.32, 95% CI 1.18–1.47, moderate certainty) and may increase the likelihood of survival with good functional outcome (RR 1.49, 95% CI 0.87–2.54, low certainty). Corticosteroids may decrease the risk of ventilator associated pneumonia (RR 0.76, 95% CI 0.46–1.09, low certainty), may increase renal failure (RR 1.29, 95% CI 0.84–1.99, low certainty), and have an uncertain effect on bleeding (RR 2.04, 95% CI 0.53–7.84, very low certainty) and peritonitis (RR 10.54, 95% CI 2.99–37.19, very low certainty). Conclusions In patients during or after cardiac arrest, corticosteroids have an uncertain effect on mortality but probably increase ROSC and may increase the likelihood of survival with good functional outcome at hospital discharge. Corticosteroids may decrease ventilator associated pneumonia, may increase renal failure, and have an uncertain effect on bleeding and peritonitis. However, the pooled evidence examining these outcomes was sparse and imprecision contributed to low or very low certainty of evidence.https://doi.org/10.1186/s13054-022-04297-2Cardiac arrestCorticosteroidsRandomized control trialMortalitySurvival with good functional outcome |
| spellingShingle | Jeremy Penn Will Douglas Jeffrey Curran Dipayan Chaudhuri Joanna C. Dionne Shannon M. Fernando David Granton Rebecca Mathew Bram Rochwerg Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials Critical Care Cardiac arrest Corticosteroids Randomized control trial Mortality Survival with good functional outcome |
| title | Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials |
| title_full | Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials |
| title_fullStr | Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials |
| title_full_unstemmed | Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials |
| title_short | Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials |
| title_sort | efficacy and safety of corticosteroids in cardiac arrest a systematic review meta analysis and trial sequential analysis of randomized control trials |
| topic | Cardiac arrest Corticosteroids Randomized control trial Mortality Survival with good functional outcome |
| url | https://doi.org/10.1186/s13054-022-04297-2 |
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