Defibrillation strategies for refractory ventricular fibrillation out-of-hospital cardiac arrest: A systematic review and network meta-analysis

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2023-07-22 DOI:10.1111/anec.13075

Mohamed T. Abuelazm MBBCh, Ahmed Ghanem MD, Basant E. Katamesh MBBCh, Abdul Rhman Hassan MBBCh, Hassan Abdalshafy MBBCh Candidate, Amith Reddy Seri MBBS, Ahmed K. Awad MBBCh, Mohamed Abdelnabi MD, Basel Abdelazeem MD

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Abstract

Background and Objective

Double sequential external defibrillation (DSED) and vector-change defibrillation (VCD) have been suggested to enhance clinical outcomes for patients with ventricular fibrillation (VF) refractory of standard defibrillation (SD). Therefore, this network meta-analysis aims to evaluate the comparative efficacy of DSED, VCD, and SD for refractory VF.

Methods

A systematic review and network meta-analysis synthesizing randomized controlled trials (RCTs) and comparative observational studies retrieved from PubMed, EMBASE, WOS, SCOPUS, and Cochrane through November 15th, 2022. R software netmeta and netrank package (R version 4.2.0) and meta-insight software were used to pool dichotomous outcomes using odds ratio (OR) presented with the corresponding confidence interval (CI). Our protocol was prospectively published in PROSPERO with ID: CRD42022378533.

Results

We included seven studies with a total of 1632 participants. DSED was similar to SD in survival to hospital discharge (OR: 1.14 with 95% CI [0.55, 2.83]), favorable neurological outcome (modified Rankin scale ≤2 or cerebral performance category ≤2) (OR: 1.35 with 95% CI [0.46, 3.99]), and return of spontaneous circulation (ROSC) (OR: 0.81 with 95% CI [0.43; 1.5]). In addition, VCD was similar to SD in survival to hospital discharge (OR: 1.12 with 95% CI [0.27, 4.57]), favorable neurological outcome (OR: 1.01 with 95% CI [0.18, 5.75]), and ROSC (OR: 0.88 with 95% CI [0.24; 3.15]).

Conclusion

Double sequential external defibrillation and VCD were not associated with enhanced outcomes in patients with refractory VF out-of-hospital cardiac arrest, compared to SD. However, the current evidence is still inconclusive, warranting further large-scale RCTs.

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难治性室颤院外心脏骤停的除颤策略:系统回顾和网络荟萃分析

背景与目的双顺序体外除颤(DSED)和载体变化除颤(VCD)被认为可以提高标准除颤(SD)难治性心室颤动(VF)患者的临床疗效。因此，本网络荟萃分析旨在评估DSED、VCD和SD治疗难治性VF的比较疗效。方法通过系统评价和网络荟萃分析，综合从PubMed、EMBASE、WOS、SCOPUS和Cochrane检索到的截至2022年11月15日的随机对照试验(rct)和比较观察性研究。采用R软件netmeta and netrank package (R version 4.2.0)和meta-insight软件，采用比值比(OR)和相应的置信区间(CI)对二分类结果进行汇总。我们的方案已前瞻性地发表在PROSPERO杂志上，ID: CRD42022378533。结果我们纳入了7项研究，共1632名受试者。DSED与SD在存活至出院(OR: 1.14, 95% CI[0.55, 2.83])、良好的神经预后(改良Rankin量表≤2或脑功能类别≤2)(OR: 1.35, 95% CI[0.46, 3.99])和自然循环恢复(ROSC) (OR: 0.81, 95% CI [0.43;1.5])。此外，VCD与SD在存活至出院(OR: 1.12, 95% CI[0.27, 4.57])、良好的神经预后(OR: 1.01, 95% CI[0.18, 5.75])和ROSC (OR: 0.88, 95% CI [0.24;3.15])。结论与SD相比，双序贯体外除颤和VCD与难治性VF院外心脏骤停患者的预后改善无关。然而，目前的证据仍然不确定，需要进一步的大规模随机对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.