Efficacy and safety of corticosteroid therapy in patients with cardiac arrest: A meta-analysis of randomized controlled trials
The clinical benefits of steroid therapy during cardiac arrest (CA) are unclear. Several recent clinical trials have shown that administering corticosteroid therapy during CA may improve patient outcomes. The purpose of the present study was to determine whether providing corticosteroids improves ou...
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| Veröffentlicht in: | The American journal of emergency medicine 2024-01, Vol.75, p.111-118 |
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| creator | Zhou, Fa-Wei Liu, Chang Li, De-Zhong Zhang, Yong Zhou, Fa-Chun |
| description | The clinical benefits of steroid therapy during cardiac arrest (CA) are unclear. Several recent clinical trials have shown that administering corticosteroid therapy during CA may improve patient outcomes. The purpose of the present study was to determine whether providing corticosteroids improves outcomes for patients following CA.
We searched the PubMed, Embase, Cochrane Library, Web of Science and CNKI databases for randomized controlled trials comparing corticosteroid therapy to placebo during CA.
Eleven relevant studies involving a total of 2273 patients were included in the meta-analysis. The statistical analysis showed that corticosteroid treatment during CA was significantly associated with an increased rate of sustained return of spontaneous circulation (ROSC) (OR: 2.05, 95% CI: 1.24 to 3.37, P |
| doi_str_mv | 10.1016/j.ajem.2023.10.031 |
| format | Article |
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We searched the PubMed, Embase, Cochrane Library, Web of Science and CNKI databases for randomized controlled trials comparing corticosteroid therapy to placebo during CA.
Eleven relevant studies involving a total of 2273 patients were included in the meta-analysis. The statistical analysis showed that corticosteroid treatment during CA was significantly associated with an increased rate of sustained return of spontaneous circulation (ROSC) (OR: 2.05, 95% CI: 1.24 to 3.37, P < 0.01). Corticosteroid treatment during CA did not show a significant benefit in favorable neurological outcomes (OR: 1.13, 95% CI: 0.81 to 1.58, P = 0.49) or overall survival rate at hospital discharge (OR: 1.29, 95% CI: 0.74 to 2.26, P = 0.38). However, in the subgroup analysis, we found that patients had a significantly increased survival rate and ROSC if the dose of corticosteroid therapy above 100 mg methylprednisolone. The statistical analysis revealed no significant differences in adverse events.
High-dose corticosteroid treatment (above 100 mg methylprednisolone) is associated with better overall survival rate at hospital discharge and ROSC outcomes. However, there is uncertainty regarding whether this treatment results in a benefit or harm to the favorable neurological outcomes at hospital discharge.</description><identifier>ISSN: 0735-6757</identifier><identifier>ISSN: 1532-8171</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2023.10.031</identifier><identifier>PMID: 37939521</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adrenal Cortex Hormones - therapeutic use ; Cardiac arrest ; Cardiopulmonary resuscitation ; Cardiopulmonary Resuscitation - methods ; Clinical trials ; Corticoids ; Corticosteroid ; Corticosteroids ; CPR ; Emergency medical care ; Heart ; Heart Arrest - therapy ; Humans ; Immunomodulators ; Intervention ; Medical prognosis ; Meta-analysis ; Methylprednisolone ; Out-of-Hospital Cardiac Arrest - therapy ; Patients ; Randomized Controlled Trials as Topic ; Statistical analysis ; Steroid ; Steroids ; Survival ; Systematic review</subject><ispartof>The American journal of emergency medicine, 2024-01, Vol.75, p.111-118</ispartof><rights>2023</rights><rights>Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2023. The Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-dcc0f5e051126db4eb5b43ca484ac0f1af03a254d69fc1d78bb33e6b77accb603</citedby><cites>FETCH-LOGICAL-c428t-dcc0f5e051126db4eb5b43ca484ac0f1af03a254d69fc1d78bb33e6b77accb603</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37939521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhou, Fa-Wei</creatorcontrib><creatorcontrib>Liu, Chang</creatorcontrib><creatorcontrib>Li, De-Zhong</creatorcontrib><creatorcontrib>Zhang, Yong</creatorcontrib><creatorcontrib>Zhou, Fa-Chun</creatorcontrib><title>Efficacy and safety of corticosteroid therapy in patients with cardiac arrest: A meta-analysis of randomized controlled trials</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>The clinical benefits of steroid therapy during cardiac arrest (CA) are unclear. Several recent clinical trials have shown that administering corticosteroid therapy during CA may improve patient outcomes. The purpose of the present study was to determine whether providing corticosteroids improves outcomes for patients following CA.
We searched the PubMed, Embase, Cochrane Library, Web of Science and CNKI databases for randomized controlled trials comparing corticosteroid therapy to placebo during CA.
Eleven relevant studies involving a total of 2273 patients were included in the meta-analysis. The statistical analysis showed that corticosteroid treatment during CA was significantly associated with an increased rate of sustained return of spontaneous circulation (ROSC) (OR: 2.05, 95% CI: 1.24 to 3.37, P < 0.01). Corticosteroid treatment during CA did not show a significant benefit in favorable neurological outcomes (OR: 1.13, 95% CI: 0.81 to 1.58, P = 0.49) or overall survival rate at hospital discharge (OR: 1.29, 95% CI: 0.74 to 2.26, P = 0.38). However, in the subgroup analysis, we found that patients had a significantly increased survival rate and ROSC if the dose of corticosteroid therapy above 100 mg methylprednisolone. The statistical analysis revealed no significant differences in adverse events.
High-dose corticosteroid treatment (above 100 mg methylprednisolone) is associated with better overall survival rate at hospital discharge and ROSC outcomes. However, there is uncertainty regarding whether this treatment results in a benefit or harm to the favorable neurological outcomes at hospital discharge.</description><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Cardiac arrest</subject><subject>Cardiopulmonary resuscitation</subject><subject>Cardiopulmonary Resuscitation - methods</subject><subject>Clinical trials</subject><subject>Corticoids</subject><subject>Corticosteroid</subject><subject>Corticosteroids</subject><subject>CPR</subject><subject>Emergency medical care</subject><subject>Heart</subject><subject>Heart Arrest - therapy</subject><subject>Humans</subject><subject>Immunomodulators</subject><subject>Intervention</subject><subject>Medical prognosis</subject><subject>Meta-analysis</subject><subject>Methylprednisolone</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Patients</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Statistical analysis</subject><subject>Steroid</subject><subject>Steroids</subject><subject>Survival</subject><subject>Systematic review</subject><issn>0735-6757</issn><issn>1532-8171</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kTtvFTEQRi1ERC6BP0CBLNGk2Yuf-0A0URQeUqQ0UFuz9qzi1e76YvsSLUV-O17dQEFBNdb4zJE9HyFvONtzxuv34x5GnPeCCVkaeyb5M7LjWoqq5Q1_TnaskbqqG92ck5cpjYxxrrR6Qc5l08lOC74jjzfD4C3YlcLiaIIB80rDQG2I2duQMsbgHc33GOGwUr_QA2SPS070wed7aiE6D5ZCjJjyB3pFZ8xQwQLTmnzaVLGYw-x_oSvWJccwTeWYo4cpvSJnQyn4-qlekO-fbr5df6lu7z5_vb66rawSba6ctWzQyDTnona9wl73SlpQrYJyw2FgEoRWru4Gy13T9r2UWPdNA9b2NZMX5PLkPcTw41heamafLE4TLBiOyYi2bZkUqusK-u4fdAzHWP6zUZ2SuinLK5Q4UTaGlCIO5hD9DHE1nJktHTOaLR2zpbP1Sjpl6O2T-tjP6P6O_ImjAB9PAJZd_PQYTbJl2Radj2izccH_z_8bl26i3Q</recordid><startdate>202401</startdate><enddate>202401</enddate><creator>Zhou, Fa-Wei</creator><creator>Liu, Chang</creator><creator>Li, De-Zhong</creator><creator>Zhang, Yong</creator><creator>Zhou, Fa-Chun</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202401</creationdate><title>Efficacy and safety of corticosteroid therapy in patients with cardiac arrest: A meta-analysis of randomized controlled trials</title><author>Zhou, Fa-Wei ; 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Several recent clinical trials have shown that administering corticosteroid therapy during CA may improve patient outcomes. The purpose of the present study was to determine whether providing corticosteroids improves outcomes for patients following CA.
We searched the PubMed, Embase, Cochrane Library, Web of Science and CNKI databases for randomized controlled trials comparing corticosteroid therapy to placebo during CA.
Eleven relevant studies involving a total of 2273 patients were included in the meta-analysis. The statistical analysis showed that corticosteroid treatment during CA was significantly associated with an increased rate of sustained return of spontaneous circulation (ROSC) (OR: 2.05, 95% CI: 1.24 to 3.37, P < 0.01). Corticosteroid treatment during CA did not show a significant benefit in favorable neurological outcomes (OR: 1.13, 95% CI: 0.81 to 1.58, P = 0.49) or overall survival rate at hospital discharge (OR: 1.29, 95% CI: 0.74 to 2.26, P = 0.38). However, in the subgroup analysis, we found that patients had a significantly increased survival rate and ROSC if the dose of corticosteroid therapy above 100 mg methylprednisolone. The statistical analysis revealed no significant differences in adverse events.
High-dose corticosteroid treatment (above 100 mg methylprednisolone) is associated with better overall survival rate at hospital discharge and ROSC outcomes. However, there is uncertainty regarding whether this treatment results in a benefit or harm to the favorable neurological outcomes at hospital discharge.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37939521</pmid><doi>10.1016/j.ajem.2023.10.031</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The American journal of emergency medicine, 2024-01, Vol.75, p.111-118 |
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| subjects | Adrenal Cortex Hormones - therapeutic use Cardiac arrest Cardiopulmonary resuscitation Cardiopulmonary Resuscitation - methods Clinical trials Corticoids Corticosteroid Corticosteroids CPR Emergency medical care Heart Heart Arrest - therapy Humans Immunomodulators Intervention Medical prognosis Meta-analysis Methylprednisolone Out-of-Hospital Cardiac Arrest - therapy Patients Randomized Controlled Trials as Topic Statistical analysis Steroid Steroids Survival Systematic review |
| title | Efficacy and safety of corticosteroid therapy in patients with cardiac arrest: A meta-analysis of randomized controlled trials |
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