Pub Date : 2024-12-01DOI: 10.1016/j.resuscitation.2024.110458
Erga Cerchiari, Giuseppe Ristagno, Federico Semeraro, Andrea Scapigliati
{"title":"Perspective on cardiac arrest survivorship: Findings from an Italian landmark survey","authors":"Erga Cerchiari, Giuseppe Ristagno, Federico Semeraro, Andrea Scapigliati","doi":"10.1016/j.resuscitation.2024.110458","DOIUrl":"10.1016/j.resuscitation.2024.110458","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110458"},"PeriodicalIF":6.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.resuscitation.2024.110414
Robert Greif EIT Chair, Janet E. Bray BLS Chair, Therese Djärv FA Chair, Ian R. Drennan ALS Chair, Helen G. Liley NLS Chair, Kee-Chong Ng PLS Chair, Adam Cheng EIT Vice Chair, Matthew J. Douma FA Vice Chair, Barnaby R. Scholefield PLS Vice Chair, Michael Smyth BLS Vice Chair, Gary Weiner NLS Vice Chair, Cristian Abelairas-Gómez, Jason Acworth, Natalie Anderson, Dianne L. Atkins, David C. Berry, Farhan Bhanji, Bernd W. Böttiger, Richard N. Bradley, Jan Breckwoldt, Katherine M. Berg Sr Editor
This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.
{"title":"2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces","authors":"Robert Greif EIT Chair, Janet E. Bray BLS Chair, Therese Djärv FA Chair, Ian R. Drennan ALS Chair, Helen G. Liley NLS Chair, Kee-Chong Ng PLS Chair, Adam Cheng EIT Vice Chair, Matthew J. Douma FA Vice Chair, Barnaby R. Scholefield PLS Vice Chair, Michael Smyth BLS Vice Chair, Gary Weiner NLS Vice Chair, Cristian Abelairas-Gómez, Jason Acworth, Natalie Anderson, Dianne L. Atkins, David C. Berry, Farhan Bhanji, Bernd W. Böttiger, Richard N. Bradley, Jan Breckwoldt, Katherine M. Berg Sr Editor","doi":"10.1016/j.resuscitation.2024.110414","DOIUrl":"10.1016/j.resuscitation.2024.110414","url":null,"abstract":"<div><div>This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110414"},"PeriodicalIF":6.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.resuscitation.2024.110452
Federico Lorenzo Barra , Alessandro Costa , Giovanna Rodella , Federico Semeraro , Luca Carenzo
{"title":"Shaping the future of simulator interactions: The role of ChatGPT’s Advanced Voice Mode","authors":"Federico Lorenzo Barra , Alessandro Costa , Giovanna Rodella , Federico Semeraro , Luca Carenzo","doi":"10.1016/j.resuscitation.2024.110452","DOIUrl":"10.1016/j.resuscitation.2024.110452","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110452"},"PeriodicalIF":6.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-30DOI: 10.1016/j.resuscitation.2024.110449
Joelle Khoury, Tal Soumagnac, Damien Vimpere, Assia El Morabity, Alice Hutin, Jean-Herlé Raphalen, Lionel Lamhaut
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear.
Methods: We conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive.
Results: A total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1-1), and half had recovered an LVEF > 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6-8.0) years. Half of these patients were actively working, with a median time of 10 months (3-21) to regain the ability to work since the onset of OHCA.
Conclusion: Most patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.
{"title":"Long-term heart function in refractory out-of-hospital cardiac arrest treated with prehospital extracorporeal cardiopulmonary resuscitation.","authors":"Joelle Khoury, Tal Soumagnac, Damien Vimpere, Assia El Morabity, Alice Hutin, Jean-Herlé Raphalen, Lionel Lamhaut","doi":"10.1016/j.resuscitation.2024.110449","DOIUrl":"10.1016/j.resuscitation.2024.110449","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear.</p><p><strong>Methods: </strong>We conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive.</p><p><strong>Results: </strong>A total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1-1), and half had recovered an LVEF > 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6-8.0) years. Half of these patients were actively working, with a median time of 10 months (3-21) to regain the ability to work since the onset of OHCA.</p><p><strong>Conclusion: </strong>Most patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110449"},"PeriodicalIF":6.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.resuscitation.2024.110438
Anthony Bishara , Romergryko G. Geocadin
{"title":"Spindles of hope: A new Frontier in adult neuroprognostication following cardiac arrest","authors":"Anthony Bishara , Romergryko G. Geocadin","doi":"10.1016/j.resuscitation.2024.110438","DOIUrl":"10.1016/j.resuscitation.2024.110438","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110438"},"PeriodicalIF":6.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.resuscitation.2024.110434
Richard A. Field
{"title":"All hands to the scopes – Time to rethink airway management in out of hospital cardiac arrest?","authors":"Richard A. Field","doi":"10.1016/j.resuscitation.2024.110434","DOIUrl":"10.1016/j.resuscitation.2024.110434","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110434"},"PeriodicalIF":6.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.resuscitation.2024.110436
Silvia Miette Pontremoli, Enrico Baldi, Alessia Currao, Simone Savastano, on behalf of the STAR study group
{"title":"Left Percutaneous Stellate Ganglion Block to treat refractory in-hospital cardiac arrest","authors":"Silvia Miette Pontremoli, Enrico Baldi, Alessia Currao, Simone Savastano, on behalf of the STAR study group","doi":"10.1016/j.resuscitation.2024.110436","DOIUrl":"10.1016/j.resuscitation.2024.110436","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110436"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-15DOI: 10.1016/j.resuscitation.2024.110435
Linn Harrysson , Emma Blick , Akil Awad , Martin Jonsson , Andreas Claesson , Carl Magnusson , Lis Abazi , Johan Israelsson , Robin Hofmann , Per Nordberg , Gabriel Riva
Introduction/aim
Out-of-hospital cardiac arrest (OHCA) with shockable pulseless ventricular tachycardia or fibrillation not responding to defibrillation is a medical challenge. Novel treatment strategies have emerged for so-called refractory ventricular fibrillation not responding to three or more defibrillations but the evidence for optimal timing for these strategies is sparse. The primary aim of this observational study was to assess survival in relation to total numbers of defibrillations in OHCA.
Methods
This is a registry-based retrospective cohort study based on data reported by the emergency medical services to the Swedish Registry of Cardiopulmonary Resuscitation and the National Patient Registry. All OHCA patients aged 18 years or older with an initial shockable rhythm in Sweden from January 1, 2010 and December 31, 2020 were included. Exposure was total number of defibrillations, and primary outcome was survival to 30 days. Logistic regression was used to adjust for patient and resuscitation characteristics.
Results
Over the study period a total of 10,549 patients were included. Among them, 3,006 (28.5%) received only one shock, 1,665 (15.8%) two shocks, 1,336 (12.9%) three shocks, 1,064 (10.1%) four shocks and 3,478 (33.0%) five or more shocks. In the adjusted analysis an exponential decrease in the 30-day survival was found for each additional defibrillation. For patients receiving one, two, three and four defibrillations, the adjusted probability of survival was 42%, 36%, 30% and 25% respectively.
Conclusions
In this registry-based retrospective cohort study, additional defibrillations were associated with a lower survival. This association persisted after adjustments for patient and resuscitation characteristics.
{"title":"Survival in relation to number of defibrillation attempts in out-of-hospital cardiac arrest","authors":"Linn Harrysson , Emma Blick , Akil Awad , Martin Jonsson , Andreas Claesson , Carl Magnusson , Lis Abazi , Johan Israelsson , Robin Hofmann , Per Nordberg , Gabriel Riva","doi":"10.1016/j.resuscitation.2024.110435","DOIUrl":"10.1016/j.resuscitation.2024.110435","url":null,"abstract":"<div><h3>Introduction/aim</h3><div>Out-of-hospital cardiac arrest (OHCA) with shockable pulseless ventricular tachycardia or fibrillation not responding to defibrillation is a medical challenge. Novel treatment strategies have emerged for so-called refractory ventricular fibrillation not responding to three or more defibrillations but the evidence for optimal timing for these strategies is sparse. The primary aim of this observational study was to assess survival in relation to total numbers of defibrillations in OHCA.</div></div><div><h3>Methods</h3><div>This is a registry-based retrospective cohort study based on data reported by the emergency medical services to the Swedish Registry of Cardiopulmonary Resuscitation and the National Patient Registry. All OHCA patients aged 18 years or older with an initial shockable rhythm in Sweden from January 1, 2010 and December 31, 2020 were included. Exposure was total number of defibrillations, and primary outcome was survival to 30 days. Logistic regression was used to adjust for patient and resuscitation characteristics.</div></div><div><h3>Results</h3><div>Over the study period a total of 10,549 patients were included. Among them, 3,006 (28.5%) received only one shock, 1,665 (15.8%) two shocks, 1,336 (12.9%) three shocks, 1,064 (10.1%) four shocks and 3,478 (33.0%) five or more shocks. In the adjusted analysis an exponential decrease in the 30-day survival was found for each additional defibrillation. For patients receiving one, two, three and four defibrillations, the adjusted probability of survival was 42%, 36%, 30% and 25% respectively.</div></div><div><h3>Conclusions</h3><div>In this registry-based retrospective cohort study, additional defibrillations were associated with a lower survival. This association persisted after adjustments for patient and resuscitation characteristics.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110435"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.resuscitation.2024.110431
Peter J. McGuigan , Ellen Pauley , Glenn Eastwood , Leanne M.C. Hays , Janus C. Jakobsen , Marion Moseby-Knappe , Alistair D. Nichol , Niklas Nielsen , Markus B. Skrifvars , Bronagh Blackwood , Daniel F. McAuley
Background
In Europe, approximately 291,000 cardiac arrests occur annually. Despite critical care therapy, hospital mortality remains high. This systematic review assessed whether, in comatose survivors of cardiac arrest, any drug therapy, compared to placebo or usual care, improves outcomes.
Methods
We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and The International Clinical Trials Registry Platform for randomized controlled trials of drug therapy in comatose survivors of cardiac arrest (last searched 20th October 2024). The primary outcome was mortality at 30 days/hospital discharge. Other outcomes reflected those of the Core Outcome Set for Cardiac Arrest. Risk of bias was assessed using Cochrane Risk-Of-Bias Version 1. Studies of steroids, coenzyme Q10 and thiamine were meta-analysed.
Results
From 2562 records, 207 full texts were screened and 45 studies (5800 patients) investigating 30 therapies were included. Studies were grouped thematically as supportive drug therapies (n = 10), neuroprotective agents (n = 19), and anti-inflammatory/antioxidants (n = 16). Four studies reported reduced mortality at 30 days/hospital discharge: one of the anticholinergic penehyclidine hydrochloride, two of intra-arrest vasopressin and methylprednisolone plus hydrocortisone for post resuscitation shock, and one of the traditional Chinese medicine, shenfu.
Studies of steroids, coenzyme Q10 and thiamine were meta-analysed. We could not detect an effect on mortality with steroids (n = 739, risk ratio (RR), 0.93; 95 % CI 0.83–1.04, p = 0.21; I2 = 60 %, low certainty), coenzyme Q10 (n = 107, RR, 0.91; 95 % CI 0.61–1.37, p = 0.65; I2 = 0 %, low certainty), or thiamine (n = 149, RR, 1.11; 95 % CI 0.88–1.40, p = 0.39; I2 = 0 %, very low certainty).
Conclusion
In comatose survivors of cardiac arrest, the majority of trials of drug therapy reported no effect on mortality. Meta-analyses of steroids, coenzyme Q10 and thiamine demonstrated no evidence of an effect on mortality. However, the low certainty of evidence warrants further research.
背景：在欧洲，每年约有 291,000 例心脏骤停。尽管进行了重症监护治疗，但住院死亡率仍然很高。本系统综述评估了与安慰剂或常规护理相比，任何药物疗法是否都能改善心脏骤停昏迷幸存者的预后：我们检索了 Medline、EMBASE、Cochrane Central Register of Controlled Trials 和 The International Clinical Trials Registry Platform，以了解针对心脏骤停昏迷幸存者的药物治疗随机对照试验（最后检索日期为 2024 年 10 月 20 日）。主要结果为出院 30 天后的死亡率。其他结果反映了心脏骤停核心结果集的结果。偏倚风险采用 Cochrane Risk-Of-Bias Version 1 进行评估。对有关类固醇、辅酶Q10和硫胺素的研究进行了荟萃分析：从 2,562 份记录中筛选出 207 篇全文，共纳入 45 项研究（5,800 名患者），调查了 30 种疗法。研究按主题分为支持性药物疗法（10 项）、神经保护剂（19 项）和抗炎/抗氧化剂（16 项）。有四项研究报告了 30 天/出院时死亡率的降低情况：一项研究使用了抗胆碱能药物盐酸哌尼环己烷，两项研究使用了用于复苏后休克的复苏中血管加压素和甲基强的松龙加氢化可的松，还有一项研究使用了传统中药神曲。对有关类固醇、辅酶 Q10 和硫胺素的研究进行了荟萃分析。我们未能发现类固醇（n = 739，风险比（RR），0.93；95 % CI 0.83-1.04，p = 0.21；I2 = 60 %，低确定性）、辅酶 Q10（n = 107，RR，0.91; 95 % CI 0.61-1.37, p = 0.65; I2 = 0 %, 低确定性）或硫胺素（n = 149, RR, 1.11; 95 % CI 0.88-1.40, p = 0.39; I2 = 0 %, 极低确定性）：结论：对于心脏骤停的昏迷幸存者，大多数药物治疗试验报告称对死亡率没有影响。类固醇、辅酶 Q10 和硫胺素的 Meta 分析表明，没有证据表明它们对死亡率有影响。然而，由于证据的确定性较低，因此需要进一步研究。
{"title":"Drug therapy versus placebo or usual care for comatose survivors of cardiac arrest; a systematic review with meta-analysis","authors":"Peter J. McGuigan , Ellen Pauley , Glenn Eastwood , Leanne M.C. Hays , Janus C. Jakobsen , Marion Moseby-Knappe , Alistair D. Nichol , Niklas Nielsen , Markus B. Skrifvars , Bronagh Blackwood , Daniel F. McAuley","doi":"10.1016/j.resuscitation.2024.110431","DOIUrl":"10.1016/j.resuscitation.2024.110431","url":null,"abstract":"<div><h3>Background</h3><div>In Europe, approximately 291,000 cardiac arrests occur annually. Despite critical care therapy, hospital mortality remains high. This systematic review assessed whether, in comatose survivors of cardiac arrest, any drug therapy, compared to placebo or usual care, improves outcomes.</div></div><div><h3>Methods</h3><div>We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and The International Clinical Trials Registry Platform for randomized controlled trials of drug therapy in comatose survivors of cardiac arrest (last searched 20th October 2024). The primary outcome was mortality at 30 days/hospital discharge. Other outcomes reflected those of the Core Outcome Set for Cardiac Arrest. Risk of bias was assessed using Cochrane Risk-Of-Bias Version 1. Studies of steroids, coenzyme Q10 and thiamine were meta-analysed.</div></div><div><h3>Results</h3><div>From 2562 records, 207 full texts were screened and 45 studies (5800 patients) investigating 30 therapies were included. Studies were grouped thematically as <strong>supportive drug therapies</strong> (n = 10), <strong>neuroprotective agents</strong> (n = 19), and <strong>anti-inflammatory/antioxidants</strong> (n = 16). Four studies reported reduced mortality at 30 days/hospital discharge: one of the anticholinergic penehyclidine hydrochloride, two of intra-arrest vasopressin and methylprednisolone plus hydrocortisone for post resuscitation shock, and one of the traditional Chinese medicine, shenfu.</div><div>Studies of steroids, coenzyme Q10 and thiamine were meta-analysed. We could not detect an effect on mortality with steroids (n = 739, risk ratio (RR), 0.93; 95 % CI 0.83–1.04, p = 0.21; I<sup>2</sup> = 60 %, low certainty), coenzyme Q10 (n = 107, RR, 0.91; 95 % CI 0.61–1.37, p = 0.65; I<sup>2</sup> = 0 %, low certainty), or thiamine (n = 149, RR, 1.11; 95 % CI 0.88–1.40, p = 0.39; I<sup>2</sup> = 0 %, very low certainty).</div></div><div><h3>Conclusion</h3><div>In comatose survivors of cardiac arrest, the majority of trials of drug therapy reported no effect on mortality. Meta-analyses of steroids, coenzyme Q10 and thiamine demonstrated no evidence of an effect on mortality. However, the low certainty of evidence warrants further research.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110431"},"PeriodicalIF":6.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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