The following is the summary of “Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials” published in the January 2023 issue of Critical care by Penn, et al.
The prognosis for those who have suffered a cardiac arrest is typically dismal. Even when a patient’s circulation has been restored, many still need vasopressor medication to keep their organs functioning. Corticosteroids have shown some promise in treating cardiac arrest. Analyze the effectiveness and safety of corticosteroids in patients who have experienced cardiac arrest both within and outside of a hospital setting. Researchers looked at ClinicalTrials.gov, EMBASE, LILACS, MEDLINE, Web of Science, CENTRAL, and ICTRP. Corticosteroids’ efficacy and safety after cardiac arrest was compared to those of a placebo or standard treatment in a meta-analysis of randomized controlled trials (RCTs).
Using a random-effects meta-analysis, researchers calculated a combined estimate of the impact size and provided it as a relative risk (RR) with 95% confidence intervals (CIs). The included trials’ was evaluated using a modified version of the Cochrane Risk of Bias(ROB) Assessment Tool, and the quality of the available evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation system. Researchers used data from 8 randomized controlled trials (n=2213 patients). Extremely little is known about the effect of corticosteroids given after cardiac arrest on mortality measured at the longest point of follow-up (RR 0.96, 95% CI 0.90-1.02; very poor certainty; needed information size not fulfilled using trial sequential analysis). There is moderate evidence that corticosteroids improve the likelihood of survival with a good functional outcome (RR 1.49, 95% CI 0.87-2.54, low certainty), and there is some evidence that they improve the likelihood of return of spontaneous circulation (ROSC) (RR 1.32, 95% CI 1.18-1.47, moderate certainty).
Corticosteroids 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), but they may reduce the risk of ventilator-associated pneumonia (RR 0.76, 95% CI 0.46-1.09, low certainty) and may increase renal failure (RR 1.29, 95% CI 0.84-1.99, low certainty). Corticosteroids definitely improve ROSC and may improve the likelihood of survival with a good functional outcome upon hospital discharge in patients undergoing or recovering from cardiac arrest, but their effect on mortality is unknown. While corticosteroids have been shown to lessen ventilator-associated pneumonia, they have been shown to exacerbate renal failure and to have unknown effects on bleeding and peritonitis. However, there needed to be more precision in the pooled evidence examining these outcomes, leading to a low or nonexistent certainty in the evidence.