Place of magnesium sulfate in cardiopulmonary resuscitation. A systematic review and meta-analysis

Abstract

INTRODUCTION: Sudden cardiac arrest treatment is challenging, And the effectiveness of resuscitation procedures — especially in pre-hospital conditions — is low. The purpose of this meta-analysis is to investigate the effects of magnesium sulfate (MgSO4) in cardiac arrest on the return of spontaneous circulation (ROSC) and survival to hospital discharge. MATERIAL AND METHODS: We searched in MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov, Web of Science up to May 25, 2020, and we conducted a systematic review and meta-analysis. We synthesized results by using mean differences, and odds ratios. The overall incidence and outcome of cardiac arrest were assessed using a random-effects meta-analysis. RESULTS: A total of 5 eligible studies were included in this meta-analysis. Survival to discharge was higher in magnesium sulfate group compared to placebo group (9,5% vs. 8.2% respectively; OR = 1.17; 95% CI: 0.61, 2.23; p = 0.64). Higher survival rate to hospital admission was observed in the placebo group — 26.9% compared to the group where magnesium was administered — 25.7% (OR = 0.93; 95% CI: 0.59, 1.47; p = 0.77. CONCLUSIONS: In conclusion, this meta-analysis indicates no statistically significant benefit of resuscitation with magnesium sulfate compared to the placebo. Thus, due to the low number of studies we recommend future randomized controlled trials to identify which anti-arrhythmic drug we should use on shock-refractory cardiac arrest.