Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 9, 2021; 10(5): 290-300
Published online Sep 9, 2021. doi: 10.5492/wjccm.v10.i5.290
Clinical benefits of corticosteroid administration during adult cardiopulmonary resuscitation: A systemic review and meta-analysis
Wachira Wongtanasarasin, Sarunsorn Krintratun
Wachira Wongtanasarasin, Sarunsorn Krintratun, Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Author contributions: Wongtanasarasin W and Krintratun S designed the protocol, contributed to data collection and data analysis; Wongtanasarasin W contributed to the formal analysis and wrote the first draft of the manuscript; all authors read and critically reviewed the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wachira Wongtanasarasin, MD, Attending Doctor, Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, 110 Intavarorot Street, Sriphum, Chiang Mai 50200, Thailand. wachir_w@hotmail.com
Received: April 9, 2021
Peer-review started: April 9, 2021
First decision: July 27, 2021
Revised: July 28, 2021
Accepted: August 6, 2021
Article in press: August 6, 2021
Published online: September 9, 2021
Abstract
BACKGROUND

The clinical benefits of steroid administration during cardiac arrest remain unclear. Several studies reported that patients who received steroids after achieving a return of spontaneous circulation (ROSC) had better outcomes, but few studies have investigated the benefits of steroid administration during resuscitation. We hypothesized that administration of steroid during cardiac arrest would be associated with better clinical outcomes in adults with cardiac arrest.

AIM

To investigate the effect of steroid administration during cardiac arrest and the outcomes of resuscitation.

METHODS

We included studies of participants older than 18 years of age who experienced cardiac arrest and included at least one arm that received corticosteroids during cardiac arrest. A literature search of PubMed and Embase on 31 January 2021 retrieved placebo-controlled studies without limitation for type, location, and initial presenting rhythm of cardiac arrest. The study outcomes were reported by odds ratios (ORs) compared with placebo. The primary outcome was survival rate at hospital discharge. Secondary outcomes included a sustained ROSC, survival rate at hospital admission, and neurological outcome at hospital discharge.

RESULTS

Six studies including 146262 participants were selected for analysis. The risk of bias ranged from low to high for randomized-controlled trials (RCTs) and low (for non-RCTs). Steroid administration was associated with increased survival at hospital discharge [OR: 3.51, 95% confidence interval (CI): 1.98-6.20, P < 0.001], and steroid administration during cardiac arrest was associated with both an increased rate of sustained ROSC (OR: 1.81, 95%CI: 1.91-4.02, P < 0.001) and a favorable neurological outcome at hospital discharge (OR: 3.02, 95%CI: 1.26-7.24, P = 0.01).

CONCLUSION

Steroid administration during cardiac arrest was associated with better outcomes of resuscitation. Further study of the use of steroid in the selected circumstances are warranted.

Keywords: Steroid, Cardiac arrest, Survival, Systematic review, Meta-analysis

Core Tip: Several studies have demonstrated that patients who receive steroids after achieving a return of spontaneous circulation (ROSC) had better outcomes. Few studies have investigated steroid administration during resuscitation, and the results are not clear. We conducted a systematic review and meta-analysis of the clinical benefits of steroids during cardiac arrest. The analysis included six studies and found that steroid administration during cardiac arrest was associated with better outcomes of resuscitation, including survival rate at hospital discharge, sustained ROSC, and favorable neurological outcome at hospital discharge.