Efficacy of combination triple therapy with vasopressin, steroid, and epinephrine in cardiac arrest: a systematic review and meta-analysis of randomized-controlled trials.

ABSTRACT

BACKGROUND: This study investigated whether combination therapy with vasopressin, steroid, and epinephrine (VSE) improves in-hospital survival and return of spontaneous circulation (ROSC) during and after resuscitation in-hospital cardiac arrest (CA). MATERIALS AND METHODS: Various databases were explored from inception until October 2021 for relevant published clinical trials and cohort studies. RESULTS: Three clinical trials were included. Pooled analysis suggested that VSE was significantly associated with increased ROSC in patients with in-hospital CA (IHCA) (odds ratio (OR) 2.281, 95% confidence interval (CI) 1.304-3.989, P value = 0.004). Meta-analysis of two studies (368 patients) demonstrated a significant difference in the reduction of mean arterial pressure (MAP) during and 15-20 min after cardiopulmonary resuscitation (standardized mean difference (SMD) 1.069, 95% CI 0.851-1.288, P value < 0.001), renal failure free days (SMD = 0.590; 95% CI 0.312-0.869 days; P value < 0.001), and coagulation failure free days (SMD = 0.403; 95% CI 0.128-0.679, P value = 0.004). However, no significant difference was observed for survival-to-discharge ratio (OR 2.082, 95% CI 0.638-6.796, P value = 0.225) and ventilator free days (SMD = 0.201, 95% CI - 0.677, 1.079 days; P value = 0.838). CONCLUSIONS: VSE combination therapy during and after IHCA may have beneficial effects in terms of the ROSC, renal and circulatory failure free days, and MAP. Prospero registration CRD42020178297 (05/07/2020).