Table 2.

Randomized Trials Including In-Hospital Cardiac Arrest Patients Between 1988 and 2018

Study	Country	Sites	Years of Inclusion	Main Inclusion Criteria	Main Exclusion Criteria	Patients	Intervention	Control	Main Findings
Brain Resuscitation Clinical Trial II Study Group,6 1991a	Multiple	24	1984-1989	IHCA, age ≥12 y, ROSC, comatose	Terminal illness, central nervous system disease, atrial fibrillation, women of childbearing age	184	Lidoflazine (calcium channel blocker)	Placebo	No difference in survival at 6 mo (12% vs 15%)
Stiell et al,7 1992a	Canada	2	1989-1992	IHCA, age ≥16 y	Terminal illness, acute trauma, in the operating or recovery rooms of hospitals	315	High-dose epinephrine (7 mg; max 5 doses)	Standard-dose epinephrine (1 mg)	No difference in ROSC (25% vs 31%) or survival to hospital discharge (5% vs 7%)
Sack et al,8 1992	United States	1	1989-1890	IHCA, age ≥18 y	Traumatic or respiratory cause, pregnancy, abdominal aortic aneurysm	103	Interposed abdominal counterpulsation CPR	Standard CPR	Higher ROSC (60% vs 25%), survival to hospital discharge (25% vs 7%), and survival to hospital discharge neurologically intact (17% vs 6%) in the intervention group
Sack et al,9 1992	United States	1	1990-1991	IHCA, age ≥18 y, initial nonshockable rhythm	Traumatic or respiratory cause, pregnancy, abdominal aortic aneurysm, recent abdominal surgery, prolonged intubation	143	Interposed abdominal counterpulsation CPR	Standard CPR	Higher ROSC (49% vs 28%) and survival at 24 h (33% vs 13%) in the intervention group. Few survived to hospital discharge
Cohen et al,10 1993	United States	1	1992-1993	IHCA, age ≥18 y, witnessed cardiac arrest	Traumatic cause, inability to achieve endotracheal intubation within 15 min	62	Active compression-decompression CPR	Standard CPR	Higher ROSC (62% vs 30%) and survival at 24 h (45% vs 9%) in the intervention group. Few survived to hospital discharge
Lipman et al,11 1993	South Africa	1	1990-1991	IHCA in the ICU, age ≥18 y, witnessed cardiac arrest, asystole	NA	37	High-dose epinephrine (10 mg)	Standard-dose epinephrine (1 mg)	No difference in ROSC (68% vs 66%) or survival at 24 h (21% vs 31%). Few patients survived to hospital discharge
Tucker et al,12 1994	United States	1	1992-1993	IHCA, age ≥18 y	Traumatic or respiratory cause, pregnancy	53	Active compression-decompression CPR	Standard CPR	Higher ROSC (60% vs 32%) and survival at 24 h (48% vs 21%) in the intervention group. No difference in survival to hospital discharge (24% vs 11%) or neurologically intact at hospital discharge (20% vs 11%)
Woodhouse et al,13 1995	Australia	1	1989-1992	IHCA or OHCA with ongoing CPR in the ED	Noncardiac cause	194 (109 with IHCA)	Epinephrine (10 mg; max 2 doses)	Placebo (max 2 doses)	No difference in ROSC (10% vs 7%). No patients survived to hospital discharge
Patrick et al,14 1995	Canada	1	1990-1992	Witnessed IHCA or OHCA with ongoing CPR in the ED	Traumatic cause, severe hypothermia/hemorrhage	145 (91 with IHCA)	Methoxamine (40 mg per dose)	Epinephrine (2 mg per dose)	No difference in ROSC (42% vs 53%), 24-h survival (30% vs 37%), or survival to hospital discharge (12% vs 15%)
Stiell et al,15 1996a	Canada	5	1993-1995	IHCA, age ≥16 y	Terminal illness; acute trauma or exsanguination; recent sternotomy; arrest in operating, recovery, or delivery room	773	Active compression-decompression CPR	Standard CPR	No difference in survival at 1 h (35% vs 35%) or at hospital discharge (10% vs 11%)
Thel et al,16 1997	United States	1	1993-1996	IHCA, age ≥18 y	Arrest in emergency, operating, or recovery room; clinical indication for magnesium; signs of irreversible death	156	Magnesium (2 g bolus + 8 g infusion over 24 h)	Placebo	No difference in ROSC (54% vs 60%), survival at 24 h (43% vs 50%), or at hospital discharge (21% vs 21%)
Stiell et al,17 2001	Canada	3	1997-1998	IHCA, age ≥16 y	Terminal illness; traumatic injury prior to admission; arrest due to exsanguination; arrest in operating, recovery, or delivery room	200	Vasopressin (40 IU; max 1 dose)	Epinephrine (1 mg)	No difference in survival at 1 h (39% vs 35%), 24 h (26% vs 24%), hospital discharge (12% vs 14%), or 30 d (13% vs 14%)
Mentzelopoulos et al,18 2009	Greece	1	2006-2007	IHCA, age ≥18 y	Terminal illness, exsanguination, treatment with IV corticosteroids prior to the cardiac arrest	100	Vasopressin (20 IU; max 5 doses) + methylprednisolone (40 mg) + hydrocortisone (300 mg/ 24 h) if in shock after cardiac arrest	Placebo	Higher ROSC (81% vs 52%) and survival to hospital discharge (19% vs 4%) in the intervention group
Weidman et al,19 2010	United States	1	2007-2008	IHCA, age ≥18 y	Arrest in emergency or operating room	98	Immersive simulation training of residents	Standard training	No difference in CPR quality between groups
Pittl et al,20 2013	Germany	1	2008-2009	IHCA or OHCA, age ≥18 y, ROSC, cardiac origin, comatose	Pregnancy, coagulation disorder, cardiogenic shock, terminal illness	80b	Invasive cooling	Surface cooling	No difference in survival to hospital discharge (62% vs 54%) or with a good neurological outcome (36% vs 36%). More bleeding complications with invasive cooling
Mentzelopoulos et al,21 2013	Greece	3	2008-2010	IHCA, age ≥18 y	Terminal illness, exsanguination, treatment with intravenous corticosteroids prior to the cardiac arrest	268	Vasopressin (20 IU; max 5 doses) + methylprednisolone (40 mg) + hydrocortisone (300 mg/ 24 h) if in shock after cardiac arrest	Placebo	Higher ROSC (84% vs 66%) and survival to hospital discharge with a good neurological outcome (14% vs 5%) in the intervention group
Vahedian-Azimi et al,22 2016	Iran	4	2014	IHCA in the ICU, age ≥18 y	NA	83	CPR with feedback devise	Standard CPR	Higher CPR quality and ROSC (72% vs 35%) in the intervention group
Eastwood et al,23 2016	Australia and New Zealand	4	2012-2014	IHCA or OHCA, age ≥18 y, mechanically ventilated	Traumatic cause, pregnancy, imminent death, raised intracranial pressure/bleeding, severe chronic airflow limitation, severe metabolic acidosis	86 (16 with IHCA	Mild hypercapnia after cardiac arrest (PaCO2 50-55 mm Hg) for 24 h	Normocapnia after cardiac arrest (PaCO2 35-45 mm Hg) for 24 h	Lower NSE values in the intervention group. No difference in survival to hospital discharge (74% vs 63%) and good neurological outcome at 6 mo (59% vs 46%)
Movahedi et al,24 2016	Iran	1	2014	IHCA, endotracheal intubation, age 18-85 y, arrest in hospital ward or ED	Traumatic cause, pregnancy, abdominal surgery in the past 2 weeks, history of abdominal aortic aneurysm, coagulopathy, ascites, active gastrointestinal bleeding, pulmonary embolism	83	Interposed abdominal counterpulsation CPR	Standard CPR	Higher end-tidal carbon dioxide in the intervention group. No difference in ROSC (60% vs 53%) or survival at 24 h (38% vs 38%)
Anantharaman et al,25 2017	Singapore	4	2005-2008	IHCA or OHCA with ongoing CPR in the ED, age ≥21 y, initial shockable rhythm	Traumatic cause, pregnancy	235 (89 with IHCA)	Escalating high-energy shocks (200-300-360 J)	Low-energy shocks (150-150 - 150 J)	No difference in first shock success (67% vs 64%), ROSC (55% vs 55%), or 30-d survival (21% vs 28%)
Koster et al,26 2017a	The Netherlands	1	2006-2014	IHCA, age ≥18 y	Traumatic cause	199	Mechanical chest compressions (AutoPulse or LUCAS)	Manuel chest compressions	No difference in serious or life-threatening visceral damage (9% vs 8%)
Zhang et al,27 2017	China	50	2012-2015	IHCA, age ≥18 y	Pregnancy, malignancy, HIV, arrest caused by brain/liver/lung disease, end-stage heart disease, Shenfu (a traditional Chinese medication including ginseng and aconite) allergy	978	Shenfu (200 mL/d for 14 d)	Standard care	Higher 28-d (43% vs 30%) and 90-d survival (40% vs 26%) in the intervention group
Look et al28 2018	Singapore	1	2006-2014	IHCA or OHCA, age 18-80 y	Traumatic cause, hemodynamically unstable, pregnancy, poor premorbid status	45 (7 with IHCA)	Invasive cooling	Surface cooling	No difference in 30-d survival (48% vs 32%) or good neurological outcome (30% vs 23%)

Abbreviations: CPR, cardiopulmonary resuscitation; ED, emergency department; IHCA, in-hospital cardiac arrest; ICU, intensive care unit; NA, not applicable; NSE: neuron-specific enolase; OHCA, out-of-hospital cardiac arrest; PaCO₂, partial pressure of carbon dioxide; ROSC, return of spontaneous circulation.

^aThe trial also included patients with OHCA, but those patients are not included in this table.

^bNumber of IHCAs not reported.