Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials

Penn, Jeremy; Douglas, Will; Curran, Jeffrey; Chaudhuri, Dipayan; Dionne, Joanna C.; Fernando, Shannon M.; Granton, David; Mathew, Rebecca; Rochwerg, Bram

doi:10.1186/s13054-022-04297-2

Critical Care

Table 2 The GRADE approach was used to assess the certainty of evidence

From: Efficacy and safety of corticosteroids in cardiac arrest: a systematic review, meta-analysis and trial sequential analysis of randomized control trials

Certainty assessment							No. of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	[Corticosteroids]	[Placebo]	Relative (95% CI)	Absolute (95% CI)	Certainty	Importance
Mortality
8	Randomised trials	Serious^a	Serious^b	Not serious	Serious^c	None	437/920 (47.5%)	548/946 (57.9%)	RR 0.96 (0.90 to 1.02)	23 more per 1000 (from 58 fewer to 12 more)	⨁◯ Very low	Critical
Return of Spontaneous Circulation
4	Randomised trials	Not serious	Not serious	Not serious	Serious^d	None	257/440 (58.4%)	210/479 (43.8%)	RR 1.32 (1.18 to 1.47)	140 more per 1000 (from 79 to 206 more)	⨁⨁⨁◯ Moderate	Critical
SURVIVAL WITH GOOD FUNCTIONAL OUTCOME
7	Randomised trials	Serious^a	Serious^b	Not serious	Serious^c	None	49/495 (9.9%)	37/534 (6.9%)	RR 1.49 (0.87 to 2.54)	34 more per 1000 (from 9 fewer to 107 more)	⨁⨁◯◯ Low	Critical
Ventilator Associated Pneumonia
2	Randomised trials	Not serious	Not serious	Not serious	Very serious^e	None	33/178 (18.5%)	29/190 (15.3%)	RR 1.21 (0.77 to 1.90)	32 more per 1000 (from 35 fewer to 137 more)	⨁⨁◯◯ Low	Critical
Bleeding
2	Randomised trials	Serious^f	Not serious	Serious^g	Very serious^e	None	6/155 (3.9%)	3/163 (1.8%)	RR 2.04 (0.53 to 7.84)	19 more per 1000 (from 9 fewer to 126 more)	⨁◯◯◯ Very low	Critical
Peritonitis
2	Randomised trials	Not serious	Not serious	Serious^h	Very serious^e	None	3/178 (1.7%)	4/190 (2.1%)	RR 0.82 (0.18 to 3.66)	4 fewer per 1000 (from 17 fewer to 56 more)	⨁◯◯◯ Very low	Important
Renal Failure
2	Randomised trials	Not serious	Not serious	Not serious	Serious^c	None	24/121 (19.8%)	2/76 (2.6%)	RR 1.29 (0.84 to 1.99)	8 more per 1000 (from 4 fewer to 26 more)	⨁⨁◯◯ Low	Important

CI confidence interval, RR risk ratio
^aHigh Risk of Bias in majority of studies assessing Mortality as an outcome
^bImportant inconsistency in effect with high Isquared and important variation upon visual inspection of the forest plot
^cWide confidence intervals with the upper end failing to exclude the possibility of harm
^dDespite precise 95% CI, number of events below optimal information size contributing to imprecision
^eVery wide confidence intervals with the upper end failing to exclude the possibility of harm
^fHigh Risk of Bias in majority of included studies assessing Bleeding as an outcome
^gVariation in importance of Bleeding between corticosteroid and control groups
^hVariation in importance of Peritonitis between corticosteroid and control groups

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ISSN: 1364-8535

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