Meta-Analysis
Copyright ©The Author(s) 2021.
World J Crit Care Med. Sep 9, 2021; 10(5): 290-300
Published online Sep 9, 2021. doi: 10.5492/wjccm.v10.i5.290
Table 1 Characteristics of the included studies
Ref.
Age, yr
Study design, country/territory, enrollment period
Sample size (exposure/control)
Location
Shockable initial rhythm (exposure/control), %
Witnessed arrest (exposure/control), %
Bystander CPR (exposure/control), %
Intervention
Comparator
Outcomes of interest
Bolvardi et al[17], 201668.9 ± 16.0RCT, Iran, 201550 (25/25)OHCA28 (20/36)N/AN/A1 mg epinephrine plus 125 mg methylpredni-solone during the first cycle of resuscitation1 mg epinephrine plus saline during the first cycle of resuscitationSuccessful resuscitation; Survival to hospital discharge; Neurological outcomes at hospital discharge
Mentzelopoulos et al[9], 200967.4RCT, Greece, Jul 2006 to Mar 2007100 (48/52)IHCA14 (15/13)81 (79/83)N/A1 IU vasopressin plus 1 mg epinephrine for the first 5 CPR cycles and 40 mg methylprednisolone. Shock after resuscitation was treated with stress-dose hydrocortisone (300 mg daily for 7 d with gradual tapering)Placebo (saline) plus 1 mg epinephrine for the first 5 CPR cycles. Shock after resuscitation was treated with saline placeboSustained ROSC; Survival to hospital discharge
Mentzelopoulos et al[7], 201363.0RCT, Greece, Sep 2008 to Oct 2010268 (130/138)IHCA16.8 (16.7/16.9)92.2 (91.3/93/1)N/A1 IU vasopressin plus 1 mg epinephrine for the first 5 CPR cycles and 40 mg methylprednisolone. Shock after resuscitation was treated with stress-dose hydrocortisone (300 mg daily for 7 d with gradual tapering)Placebo (saline) plus 1 mg epinephrine for the first 5 CPR cycles. Shock after resuscitation was treated with saline placeboROSC ≥ 20 min; Survival to hospital discharge; Neurological outcomes at hospital discharge
Paris et al[10], 1984N/ARCT, United States, Mar 1982 to Jan 198383 (37/46)OHCA48.2 (41.3/56.8)N/A30.1 (36.9/21.6)100 mg dexamethasoneThe same volume of salineSurvival to hospital admission; Survival to hospital discharge
Tsai et al[11], 200772.5 ± 16.2Prospective non-RCT, Taiwan, Oct 2004 to Jul 200597 (36/61)Non-trauma, OHCA10.3 (11/10)75.3 (83/71)N/A100 mg hydrocortisoneSaline as placeboSustained ROSC; Survival to hospital discharge
Tsai et al[18], 201668.2Retrospective, Taiwan, 2004-2011145644 (2912/142732)IHCA (at the ED)20.6 (33.4/20.3)N/AN/AAny forms of steroid useNo steroid useSurvival to hospital admission; Survival to hospital discharge; 1-yr survival
Table 2 Cochrane risk of bias assessment tool for randomized trials and the Good Research for Comparative Effectiveness checklist for nonrandomized trials
Randomized-controlled trials
Ref.
Randomization
Deviation from the intended interventions
Missing outcome data
Measurement of outcome
Selection of the reported result
Overall
Bolvardi et al[17], 2016LowHighSome concernsLowSome concernsHigh
Mentzelopoulos et al[9], 2009LowLowLowLowLowLow
Mentzelopoulos et al[7], 2013LowLowLowLowLowLow
Paris et al[10], 1984HighLowSome concernsLowSome concernsHigh
Non-randomized-controlled trials
Ref.Adequate treatmentAdequate outcomesObjective outcomesValid outcomesSimilar outcomesCovariates recordedNew initiatorsConcurrent comparatorsCovariates accounted forImmortal time biasSensitivity analysis
D1D2D3D4D5D6M1M2M3M4M5
Tsai et al[11], 2007+++++++++++
Tsai et al[18], 2016+++++++++++