Meds Fail to Improve Survival in Comatose Cardiac Arrest

TOPLINE:

Compared with placebo or standard care, steroids, coenzyme Q10, and thiamine fail to reduce mortality rates in comatose survivors of cardiac arrest.

METHODOLOGY:

• This meta-analysis included 45 randomized clinical trials (5800 patients) analyzing 30 different drugs that were categorized as supportive drugs (10 studies), neuroprotective agents (19 studies), and anti-inflammatory/antioxidants (16 studies), with data up to October 2024.
• The included studies on comatose survivors of cardiac arrest (age ≥ 16 years) compared any drug therapy with placebo or usual care, with outcomes based on the Core Outcome Set for Cardiac Arrest.
• The primary outcome was 30-day mortality or hospital discharge; the secondary outcomes included short-, medium-, and long-term mortality and functional outcomes.

TAKEAWAY:

• The 30-day mortality or hospital discharge rate was 60.2% in 38 studies (84.4%), with intervention groups showing lower rates than control groups (57.8% vs 62.6%).
• Meta-analyses showed no significant differences in mortality in five studies of steroids (739 patients; risk ratio [RR], 0.93; P = .21), three studies of coenzyme Q10 (107 patients; RR, 0.91; P =.65), or three studies of thiamine (149 patients; RR, 1.11; P =.39), all with a low certainty of evidence.
• Four studies reported reduced 30-day mortality, including one study of penehyclidine hydrochloride, two of vasopressin and methylprednisolone plus hydrocortisone for postresuscitation shock (149 patients; RR, 0.84), and one of Shenfu (705 patients; RR, 0.81).
• Functional outcomes improved within 30 days with vasopressin, steroids (149 patients; RR, 2.73), and Shenfu (705 patients; RR, 1.70).

IN PRACTICE:

“The majority of trials of drug therapy after cardiac arrest reported no effect on mortality. However, sample sizes were small. Our meta-analyses revealed no evidence of an effect on mortality with steroids, coenzyme Q10 or thiamine. Many knowledge gaps and research priorities remain poorly studied, highlighting the need for future research to improve outcomes after cardiac arrest,” the authors concluded.

SOURCE:

The study was led by Peter J. McGuigan, Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, United Kingdom, and was published online on November 14, 2024, in Resuscitation.

LIMITATIONS:

The broad focus of the study raised the possibility of missing relevant trials, and excluding drugs used only during cardiac arrest may have overlooked treatments for postcardiac arrest syndrome. Heterogeneity-limited meta-analyses of certain drugs and quality-of-life outcomes have not been reported.

DISCLOSURES:

The study received funding from the Belfast Health and Social Care Trust, Research Charitable Funds, Swedish Research Council, and Swedish ALF program. Several authors have reported financial relationships, including receiving consulting fees, grants, and honoraria from various organizations; leadership roles; and patents. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.