OBJECTIVES To assess the effect of vasopressin, steroid and epinephrine (VSE) combination therapy on return of spontan-eous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and test the conclusiveness of evidence using trial sequential ana-lysis (TSA). METHODS The systematic search included PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) that included adult patients with IHCA, with at least one group receiving combined VSE therapy were selected. Data was extracted independently by two reviewers. The main outcome of interest was ROSC. Other out-comes included survival to hospital discharge or survival to 30 and 90 days, with good neurological outcomes. RESULTS We included a total of three RCTs (n = 869). Results showed that VSE combination therapy increased ROSC (risk ra-tio = 1.41; 95％ CI: 1.25-1.59) as compared to placebo. TSA demonstrated that the existing evidence is conclusive. This was also validated by the alpha-spending adjusted relative risk (1.32 [1.16, 1.49], P < 0.0001). Other outcomes could not be meta-analysed due to differences in timeframe in the included studies. CONCLUSIONS VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC. Fu-ture trials of VSE therapy should evaluate survival to hospital discharge, neurological function and long-term survival.

Danish Iltaf Satti;Yan Hiu Athena Lee;Keith Sai Kit Leung;Jeremy Man Ho Hui;Thompson Ka Ming Kot;Arslan Babar;Gauranga Mahalwar;Abraham KC Wai;Tong Liu;Leonardo Roever;Gary Tse;Jeffrey Shi Kai Chan;International Health Informatics Study(IHIS)Network

Cardiovascular Analytics Group,Hong Kong,China-UK Collaboration;Emergency Medicine Unit,Li Ka Shing Fac-ulty of Medicine,The University of Hong Kong,Hong Kong,China;Aston Medical School,Faculty of Health&Life Sciences,Aston University,Birmingham,United Kingdom;Li Ka Shing Faculty of Medicine,The University of Hong Kong,Hong Kong,China;Department of Anaesthesia and Pain Service,Princess Margaret Hospital,Lai Chi Kok,Kowloon,Hong Kong,China;Department of Medicine,Cleveland Clinic Foundation,Cleveland,USA;Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease,Department of Cardiology,Tianjin Institute of Cardi-ology,Second Hospital of Tianjin Medical University,Tianjin,China;Department of Clinical Research,Federal Uni-versity of Uberlandia,Uberlandia,Brazil;Kent and Medway Medical School,Canterbury,Kent,United Kingdom

老年心脏病学杂志（英文版）

[1]Danish Iltaf Satti;Yan Hiu Athena Lee;Keith Sai Kit Leung;Jeremy Man Ho Hui;Thompson Ka Ming Kot;Arslan Babar;Gauranga Mahalwar;Abraham KC Wai;Tong Liu;Leonardo Roever;Gary Tse;Jeffrey Shi Kai Chan;International Health Informatics Study(IHIS)Network-.Efficacy of vasopressin, steroid, and epinephrine protocol for in-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis)[J].老年心脏病学杂志（英文版）,2022(09):705-711

OBJECTIVES,VSE,spontan,conclusiveness

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