Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis
<h3>Background </h3><p dir="ltr">The effectiveness of vasopressors in out-of-hospital cardiac arrest (OHCA) remains unclear, despite their widespread use. </p><h3>Objectives</h3><p dir="ltr">This meta-analysis investigates the impact of d...
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| مؤلفون آخرون: | , , , , , , |
| منشور في: |
2025
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إضافة وسم
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| _version_ | 1864513537478492160 |
|---|---|
| author | Eman E. Shaban (17337676) |
| author2 | Yavuz Yigit (17788490) Ahmed Shaban (5860202) Amira Shaban (21797471) Mohamed Elgassim (19261609) Benny Ponappan (21797474) Kaleem Basharat (14150061) Hany A. Zaki (17337673) |
| author2_role | author author author author author author author |
| author_facet | Eman E. Shaban (17337676) Yavuz Yigit (17788490) Ahmed Shaban (5860202) Amira Shaban (21797471) Mohamed Elgassim (19261609) Benny Ponappan (21797474) Kaleem Basharat (14150061) Hany A. Zaki (17337673) |
| author_role | author |
| dc.creator.none.fl_str_mv | Eman E. Shaban (17337676) Yavuz Yigit (17788490) Ahmed Shaban (5860202) Amira Shaban (21797471) Mohamed Elgassim (19261609) Benny Ponappan (21797474) Kaleem Basharat (14150061) Hany A. Zaki (17337673) |
| dc.date.none.fl_str_mv | 2025-06-09T03:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1016/j.jemermed.2025.05.014 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/Comparative_Efficacy_and_Safety_of_Intravenous_Vasopressors_in_Pre-Hospital_Cardiac_Arrest_A_Systematic_Review_and_Meta-Analysis/29655515 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Cardiovascular medicine and haematology Pharmacology and pharmaceutical sciences Health sciences Epidemiology Out-of-Hospital Cardiac Arrest (OHCA) Vasopressors Epinephrine Vasopressin Return of Spontaneous Circulation (ROSC) Survival to Hospital Admission (SHA) |
| dc.title.none.fl_str_mv | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <h3>Background </h3><p dir="ltr">The effectiveness of vasopressors in out-of-hospital cardiac arrest (OHCA) remains unclear, despite their widespread use. </p><h3>Objectives</h3><p dir="ltr">This meta-analysis investigates the impact of different intravenous (IV) vasopressors on survival rates and neurological function in OHCA patients. </p><h3>Methods</h3><p dir="ltr">A comprehensive search was conducted using PubMed, Medline, Embase, and Google Scholar for studies comparing vasopressor efficacy. The analysis included 30 studies with 949,511 OHCA patients. Data on the return of spontaneous circulation (ROSC), survival to hospital admission (SHA), survival to hospital discharge (SHD), 1-month survival, and neurological outcomes were pooled using a random-effects model. The overall effect size was calculated using Odds Ratios (OR) with 95% confidence intervals (CI). </p><h3>Results</h3><p dir="ltr">IV epinephrine improved prehospital ROSC (OR: 2.92, p=0.0006) and SHA (OR: 1.57, p=0.01) but did not affect SHD (OR: 0.99, p=0.96) or 1-month survival (OR: 1.10, p=0.59). Fewer patients treated with epinephrine achieved favorable neurological outcomes (OR: 0.70, p=0.005). High-dose epinephrine (HDE) improved ROSC (OR: 1.19, p=0.003) and SHA (OR: 1.20, p=0.04) over standard-dose epinephrine (SDE) but not SHD or neurological outcomes. Vasopressin showed moderate benefits over epinephrine for SHA (OR: 0.71, p=0.03), but epinephrine combined with vasopressin or norepinephrine offered no added benefits. </p><h3>Conclusions</h3><p dir="ltr">Epinephrine increases ROSC and SHA in OHCA patients but may worsen neurological outcomes. HDE improves ROSC and SHA over SDE but does not enhance SHD or neurological outcomes. Vasopressin offers moderate benefits, but combinations with other vasopressors do not improve outcomes.</p><h2>Other Information</h2><p dir="ltr">Published in: The Journal of Emergency Medicine<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1016/j.jemermed.2025.05.014" target="_blank">https://dx.doi.org/10.1016/j.jemermed.2025.05.014</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_a728088cf0fc03405d620d20e806c815 |
| identifier_str_mv | 10.1016/j.jemermed.2025.05.014 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/29655515 |
| publishDate | 2025 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-AnalysisEman E. Shaban (17337676)Yavuz Yigit (17788490)Ahmed Shaban (5860202)Amira Shaban (21797471)Mohamed Elgassim (19261609)Benny Ponappan (21797474)Kaleem Basharat (14150061)Hany A. Zaki (17337673)Biomedical and clinical sciencesCardiovascular medicine and haematologyPharmacology and pharmaceutical sciencesHealth sciencesEpidemiologyOut-of-Hospital Cardiac Arrest (OHCA)VasopressorsEpinephrineVasopressinReturn of Spontaneous Circulation (ROSC)Survival to Hospital Admission (SHA)<h3>Background </h3><p dir="ltr">The effectiveness of vasopressors in out-of-hospital cardiac arrest (OHCA) remains unclear, despite their widespread use. </p><h3>Objectives</h3><p dir="ltr">This meta-analysis investigates the impact of different intravenous (IV) vasopressors on survival rates and neurological function in OHCA patients. </p><h3>Methods</h3><p dir="ltr">A comprehensive search was conducted using PubMed, Medline, Embase, and Google Scholar for studies comparing vasopressor efficacy. The analysis included 30 studies with 949,511 OHCA patients. Data on the return of spontaneous circulation (ROSC), survival to hospital admission (SHA), survival to hospital discharge (SHD), 1-month survival, and neurological outcomes were pooled using a random-effects model. The overall effect size was calculated using Odds Ratios (OR) with 95% confidence intervals (CI). </p><h3>Results</h3><p dir="ltr">IV epinephrine improved prehospital ROSC (OR: 2.92, p=0.0006) and SHA (OR: 1.57, p=0.01) but did not affect SHD (OR: 0.99, p=0.96) or 1-month survival (OR: 1.10, p=0.59). Fewer patients treated with epinephrine achieved favorable neurological outcomes (OR: 0.70, p=0.005). High-dose epinephrine (HDE) improved ROSC (OR: 1.19, p=0.003) and SHA (OR: 1.20, p=0.04) over standard-dose epinephrine (SDE) but not SHD or neurological outcomes. Vasopressin showed moderate benefits over epinephrine for SHA (OR: 0.71, p=0.03), but epinephrine combined with vasopressin or norepinephrine offered no added benefits. </p><h3>Conclusions</h3><p dir="ltr">Epinephrine increases ROSC and SHA in OHCA patients but may worsen neurological outcomes. HDE improves ROSC and SHA over SDE but does not enhance SHD or neurological outcomes. Vasopressin offers moderate benefits, but combinations with other vasopressors do not improve outcomes.</p><h2>Other Information</h2><p dir="ltr">Published in: The Journal of Emergency Medicine<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1016/j.jemermed.2025.05.014" target="_blank">https://dx.doi.org/10.1016/j.jemermed.2025.05.014</a></p>2025-06-09T03:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1016/j.jemermed.2025.05.014https://figshare.com/articles/journal_contribution/Comparative_Efficacy_and_Safety_of_Intravenous_Vasopressors_in_Pre-Hospital_Cardiac_Arrest_A_Systematic_Review_and_Meta-Analysis/29655515CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/296555152025-06-09T03:00:00Z |
| spellingShingle | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis Eman E. Shaban (17337676) Biomedical and clinical sciences Cardiovascular medicine and haematology Pharmacology and pharmaceutical sciences Health sciences Epidemiology Out-of-Hospital Cardiac Arrest (OHCA) Vasopressors Epinephrine Vasopressin Return of Spontaneous Circulation (ROSC) Survival to Hospital Admission (SHA) |
| status_str | publishedVersion |
| title | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis |
| title_full | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis |
| title_fullStr | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis |
| title_short | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis |
| title_sort | Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis |
| topic | Biomedical and clinical sciences Cardiovascular medicine and haematology Pharmacology and pharmaceutical sciences Health sciences Epidemiology Out-of-Hospital Cardiac Arrest (OHCA) Vasopressors Epinephrine Vasopressin Return of Spontaneous Circulation (ROSC) Survival to Hospital Admission (SHA) |