The impact of vasopressor choice in patients with hypotension after cardiac arrest: a systematic review
Bibliographic record
Abstract
PURPOSE: To conduct a systematic review to evaluate the effects of vasopressor choice in adults following cardiac arrest. METHOD: We searched 12 databases until 2nd May 2025 to identify studies that evaluated the clinical effectiveness of vasopressor choice in adults with hypotension following return of spontaneous circulation. Our outcomes of interest included survival and survival with favourable neurologic function. We assessed the risks of bias using the Cochrane Risk of Bias tool version 2 for randomised trials and the Risk of Bias in Non-randomised Studies - of Interventions tool for non-randomised studies. We evaluated the certainty of evidence using GRADE. RESULTS: We included eight studies (one RCT; seven non-randomised studies), which evaluated four comparisons, namely noradrenaline versus adrenaline (six studies), noradrenaline versus dopamine (one study), noradrenaline versus noradrenaline and dopamine (one study), and dopamine versus noradrenaline and adrenaline (one study). Study heterogeneity precluded meta-analysis. The single RCT found no evidence of difference in outcomes between noradrenaline and adrenaline. Results from other studies comparing noradrenaline and adrenaline were inconsistent. Some studies found no difference in outcomes, while others suggested an association between adrenaline use and worse outcomes. Across all studies, risk of bias was assessed as moderate or high, and evidence certainty for all comparisons and outcomes was assessed as very low. CONCLUSIONS: Existing evidence does not support the use of any specific vasopressor to treat hypotension following cardiac arrest and return of spontaneous circulation. There is a need for randomised controlled trials to identify the optimum strategy for blood pressure management following cardiac arrest and return of spontaneous circulation. REVIEW REGISTRATION: PROSPERO CRD42024549394, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024549394.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.059 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.011 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".