Mortality, morbidity & clinical outcome with different types of vasopressors in out of hospital cardiac arrest patients- A systematic review and meta-analysis

Background & objective: Despite their continued use, the effectiveness and safety of vasopressors in post-cardiac arrest patients remain controversial. This study examined the efficacy of various vasopressors in cardiac arrest patients in terms of clinical, morbidity, and mortality outcomes.Methods: A comprehensive literature search was performed using online databases (MeSH terms: MEDLINE (Ovid), CENTRAL (Cochrane Library), Embase (Ovid), CINAHL, Scopus, and Google Scholar) from 1997 to 2023 for relevant English language studies. The primary outcomes of interest for this study included short-term survival leading to death, return of spontaneous circulation (ROSC), survival to hospital discharge, neurological outcomes, survival to hospital admission, myocardial infarction, and incidence of arrhythmias.Results: In this meta-analysis, 26 studies, including 16 RCTs and ten non-RCTs, were evaluated. The focus was on the efficacy of epinephrine, vasopressin, methylprednisolone, dopamine, and their combinations in medical emergencies. Epinephrine treatment was associated with better odds of survival to hospital discharge (OR = 1.52, 95%CI [1.20, 1.94]; p \u3c 0.001) and achieving ROSC (OR = 3.60, 95% CI [3.45, 3.76], P \u3c 0.00001)) over placebo but not in other outcomes of interest such as short-term survival/ death at 28-30 days, survival to hospital admission, or neurological function. In addition, our analysis indicates non-superiority of vasopressin or epinephrine vasopressin-plus-epinephrine therapy over epinephrine monotherapy except for survival to hospital admission where the combinatorial therapy was associated with better outcome (0.76, 95%CI [0.64, 0.92]; p = 0.004). Similarly, we noted the non-superiority of vasopressin-plus-methylprednisolone versus placebo. Finally, while higher odds of survival to hospital discharge (OR = 3.35, 95%CI [1.81, 6.2]; p \u3c 0.001) and ROSC (OR = 2.87, 95%CI [1.97, 4.19]; p \u3c 0.001) favoring placebo over VSE therapy were observed, the risk of lethal arrhythmia was not statistically significant. There was insufficient literature to assess the effects of dopamine versus other treatment modalities meta-analytically.Conclusion: This meta-analysis indicated that only epinephrine yielded superior outcomes among vasopressors than placebo, albeit limited to survival to hospital discharge and ROSC. Additionally, we demonstrate the non-superiority of vasopressin over epinephrine, although vasopressin could not be compared to placebo due to the paucity of data. The addition of vasopressin to epinephrine treatment only improved survival to hospital admission

A rare type of primary CD19-negative diffuse large B-cell lymphoma presenting as an infraorbital mass in the maxillary sinus

A 38-year-old male recently diagnosed with acute on chronic rhinosinusitis and orbital cellulitis presented with a right painful infraorbital mass and swelling. Fine needle aspiration of the mass demonstrated atypical lymphoid infiltrate highly suggestive of lymphoma. Flow cytometry and immunophenotypic analysis detected an abnormal lymphocytic population characterized by positive CD20, CD38, and CD10, however, the CD19 marker was negative. Whole-body positron emission tomography showed a sizeable hypermetabolic mass centered at the right maxillary sinus, extending into the right orbit, and several hypermetabolic lymph nodes in the right neck. A diagnosis of high-grade CD19-negative DLBCL was made and the patient was initiated on R-HyperCVAD (Rituximab- cyclophosphamide, vincristine, Adriamycin, dexamethasone) chemotherapy protocol.The diagnosis of paranasal lymphoma may remain elusive for months leading to delays in treatment, thus a high index of suspicion is warranted. The loss of CD19 expression in DLBCL represents a diagnostic challenge because this surface marker is widely used to gate the B cells for immunophenotyping and flow cytometry analysis. It also leads to therapeutic limitations to CD19 targeting therapies

Predictors of gastrointestinal bleeding in patients following left ventricular assist device implantation: A systematic review and meta-analysis

Aim: Our study aims to provide a more holistic understanding of the available data and predictive risk factors for gastrointestinal bleed (GIB).Materials & methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science Core Collection and calculated relative risk and meta-regression was utilized to evaluate for risk factors in order to assess the effect of covariates. Results: Our meta-analysis reported a pooled prevalence rate of GIB of 24.4%. Meta-regression analysis did not yield a statistically significant association between GIB and risk factors, including age, gender, hypertension, chronic kidney disease and diabetes. Conclusion: Studies investigating larger sample sizes are required for conclusive findings

Predictors of gastrointestinal bleeding in patients following left ventricular assist device implantation: a systematic review and meta-analysis

Aim: Our study aims to provide a more holistic understanding of the available data and predictive risk factors for gastrointestinal bleed (GIB). Materials & Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Web of Science Core Collection and calculated relative risk and meta-regression was utilized to evaluate for risk factors in order to assess the effect of covariates. Results: Our meta-analysis reported a pooled prevalence rate of GIB of 24.4%. Meta-regression analysis did not yield a statistically significant association between GIB and risk factors, including age, gender, hypertension, chronic kidney disease and diabetes. Conclusion: Studies investigating larger sample sizes are required for conclusive findings

Supplementary Figure 2: Predictors of gastrointestinal bleeding in patients following left ventricular assist device implantation: a systematic review and meta-analysis.docx

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Supplementary Figure 5: Predictors of gastrointestinal bleeding in patients following left ventricular assist device implantation: a systematic review and meta-analysis.docx

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Supplementary Figure 1: Predictors of gastrointestinal bleeding in patients following left ventricular assist device implantation: a systematic review and meta-analysis.docx

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Supplementary Figure 4: Predictors of gastrointestinal bleeding in patients following left ventricular assist device implantation: a systematic review and meta-analysis.docx

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Supplementary Figure 3: Predictors of gastrointestinal bleeding in patients following left ventricular assist device implantation: a systematic review and meta-analysis.docx

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