Purpose: This systematic review and meta-analysis (SRMA) was conducted to assess the effect and safety of steroids administration during cardiopulmonary resuscitation (CPR) in adult in-hospital cardiac arrest (IHCA) outcomes. Outcomes studied were the rate of return of spontaneous circulation (ROSC), survival to hospital discharge (STHD), and favorable neurological outcome (FNO) at discharge.

Methods: The databases PubMed, EMBASE, and Web of Science were till November-28, 2021, limiting to studies that reported the effectiveness of steroids on IHCA outcomes. We included randomised controlled trials (RCTs) in which steroids were used during the CPR of IHCA patients. Studies on the effect of post-ROSC steroids, studies conducted on OHCA patients, pediatric age (<18years) and non-randomised studies were excluded. Data on the IHCA characteristics, outcomes, as well as adverse events of steroids, were collected for the analysis. Generic inverse variance was used for meta-analysis and risk ratio (RR) was used as the effect size. Trial sequential anlaysis (TSA) was conducted to investigate whether further RCTs are needed to find out the effect of steroids on arrest outcomes and what should be the required information size (RIS) required to find a valid result.

Results: Out of 121 articles, only four studies were included. Three studies used methylprednisolone (40mg in two studies and 125mg in one study) and vasopressin. A total of 919 patients (steroid arm: 440, control arm: 479) were included. The RR of achieving ROSC in the steroid arm was 1.32 (95%CI:1.18-1.47) as compared to the control arm, which was statistically significant. The utility of steroids didn’t confer benefits in terms of other outcomes, i.e., STHD (RR:1.71,95%CI:0.78-3.73) and FNO (RR:1.60,95%CI:0.85-3.01). None of the analyses had significant statistical heterogeneity. It was found that the rates of complications like ventilator-associated pneumonia, peritonitis, and bleeding were similar in both arms. The RIS for ROSC, STHD and FNO was 409, 2930 and 2981, respectively whereas the sample size of this meta-analysis was 919. This showed that no further studies are needed to prove the benefial effects of steroids on achieving ROSC. 
Conclusion: We found that administration of steroids during CPR of IHCA patients leads to higher ROSC (no need of any new studies). The complication rates were similar in both the study arms, signifying steroids as a safe medication in CPR.

Utility of steroids in resuscitation of in-hospital cardiac arrest: A Systematic Review and Meta-analysis

Implementation of the Guidelines - How do we put the new ERC Guidelines into practice?

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