Effect of corticosteroid administration on cardiac arrest: a systematic review and network meta-analysis of the timing of administration

Corticosteroids may have a beneficial effect on the outcome of cardiac arrest (CA); however, it is not known whether the timing of corticosteroid use affects the outcome. We performed a systematic review and network meta-analysis to compare the efficacy of corticosteroid administration according to the timing. A favorable final outcome, as the primary study outcome, was de-fined as a combination of survival with good neurologic outcome and survival for 1 year. The secondary outcome was survival to discharge. Nine clinical studies were included. Corticoste-roids administered during cardiopulmonary resuscitation (CPR; odds ratio [OR], 1.29; 95% confidence interval [CI], 1.11–1.51) and post-CA (OR, 1.47; 95% CI, 1.30–1.66) had a positive effect on the favorable final outcome compared to the control protocol (no corticosteroid administra-tion), while those used prior to CA had a negative effect. Corticosteroids administered post-CA had a positive effect on survival to discharge compared to the control protocol (OR, 1.82; 95% CI, 1.02–3.27), while those used prior to CA and during CPR had no significant effect. Post-CA was evaluated to be the best administration timing for both outcomes. In conclusion, the timing of corticosteroid administration may be an important factor for the prognosis of CA. Corticoste-roids administration post-CA and during CPR may have beneficial effects on CA outcomes.