Amitava Layek1, Souvik Maitra2, Sugata Pal3, Sulagna Bhattacharjee4, Dalim K Baidya5. 1. Department of Anaesthesiology, CNBC, New Delhi, India. 2. Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Anaesthesiology & Intensive Care, JPNATC, All India Institute of Medical Sciences, New Delhi, India. 4. Department of Anaesthesiology & Intensive Care, All India Institute of Medical Sciences, New Delhi, India. Electronic address: bhattacharjee.sulagna85@gmail.com. 5. Department of Anaesthesiology & Intensive Care, CDER, All India Institute of Medical Sciences, New Delhi, India.
Abstract
BACKGROUND: 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.
BACKGROUND: 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 arrestpatients 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.
Authors: Laurence M Katz; Jonathan E Frank; Lawrence T Glickman; Gerald McGwin; Brice H Lambert; Christopher J Gordon Journal: Resuscitation Date: 2015-04-20 Impact factor: 5.262
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Authors: Lars W Andersen; Birthe Sindberg; Mathias Holmberg; Dan Isbye; Jesper Kjærgaard; Stine T Zwisler; Søren Darling; Jacob Moesgaard Larsen; Bodil S Rasmussen; Bo Løfgren; Kasper Glerup Lauridsen; Kim B Pælestik; Christoffer Sølling; Anders G Kjærgaard; Dorte Due-Rasmussen; Fredrik Folke; Mette Gitz Charlot; Kasper Iversen; Martin Schultz; Sebastian Wiberg; Rikke Malene H G Jepsen; Tobias Kurth; Michael Donnino; Hans Kirkegaard; Asger Granfeldt Journal: Resusc Plus Date: 2021-01-30