Clinical benefits of corticosteroid administration during adult cardiopulmonary resuscitation: A systemic review and meta-analysis

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], 2016	68.9 ± 16.0	RCT, Iran, 2015	50 (25/25)	OHCA	28 (20/36)	N/A	N/A	1 mg epinephrine plus 125 mg methylpredni-solone during the first cycle of resuscitation	1 mg epinephrine plus saline during the first cycle of resuscitation	Successful resuscitation; Survival to hospital discharge; Neurological outcomes at hospital discharge
Mentzelopoulos et al[9], 2009	67.4	RCT, Greece, Jul 2006 to Mar 2007	100 (48/52)	IHCA	14 (15/13)	81 (79/83)	N/A	1 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 placebo	Sustained ROSC; Survival to hospital discharge
Mentzelopoulos et al[7], 2013	63.0	RCT, Greece, Sep 2008 to Oct 2010	268 (130/138)	IHCA	16.8 (16.7/16.9)	92.2 (91.3/93/1)	N/A	1 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 placebo	ROSC ≥ 20 min; Survival to hospital discharge; Neurological outcomes at hospital discharge
Paris et al[10], 1984	N/A	RCT, United States, Mar 1982 to Jan 1983	83 (37/46)	OHCA	48.2 (41.3/56.8)	N/A	30.1 (36.9/21.6)	100 mg dexamethasone	The same volume of saline	Survival to hospital admission; Survival to hospital discharge
Tsai et al[11], 2007	72.5 ± 16.2	Prospective non-RCT, Taiwan, Oct 2004 to Jul 2005	97 (36/61)	Non-trauma, OHCA	10.3 (11/10)	75.3 (83/71)	N/A	100 mg hydrocortisone	Saline as placebo	Sustained ROSC; Survival to hospital discharge
Tsai et al[18], 2016	68.2	Retrospective, Taiwan, 2004-2011	145644 (2912/142732)	IHCA (at the ED)	20.6 (33.4/20.3)	N/A	N/A	Any forms of steroid use	No steroid use	Survival to hospital admission; Survival to hospital discharge; 1-yr survival

CPR: Cardiopulmonary resuscitation; ED: Emergency department; IHCA: In-hospital cardiac arrest; N/A: Not applicable; OHCA: Out-of-hospital cardiac arrest; RCT: Randomized-controlled trial; ROSC: Return of spontaneous circulation.