People who suffer a cardiac arrest often face a difficult road to recovery. They need treatments that help them wake up and move again. A new analysis looked at immune-modulating drugs for these patients. The study included 2,605 adults who had an out-of-hospital or in-hospital cardiac arrest. Researchers checked if these drugs improved brain function or lowered death risk. They also measured inflammation markers in the blood. The results were mixed. The drugs did not increase the risk of bad brain outcomes. They also did not lower the risk of dying within 30 days. Some data suggested a slight drop in inflammation levels after one steroid was used. This was a trend, not a confirmed result. The study had many limits. The drugs varied in type and dose. Timing of treatment was different for each patient. These differences make it hard to draw firm conclusions. The overall quality of the evidence was limited. This review supports the need for better trials to find real treatments.
Immunomodulatory therapies showed no mortality benefit or neurological harm in 2605 adults after cardiac arrestNew drug review shows no benefit for heart attack survivors
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Key Takeaway
Consider that immunomodulatory therapies showed no mortality benefit or neurological harm in cardiac arrest patients.
This systematic review and meta-analysis examined the use of immunomodulatory therapeutics in adults following both in- and out-of-hospital cardiac arrest. The study population comprised 2605 patients, and the analysis covered interventions including corticosteroids, interleukin-6 receptor blockade, and calcineurin inhibition. The primary focus was on safety and efficacy regarding functional neurological outcome, mortality at 30 days, and inflammatory biomarker levels.
Results indicated that immunomodulatory therapies were not associated with an increase in favorable neurological outcome, with a risk ratio of 1.04 and a 95% CI of [0.85, 1.28]. Similarly, these therapies were not associated with a decrease in mortality, showing a risk ratio of 0.97 and a 95% CI of [0.91, 1.03]. A trend toward decreased IL-6 levels at 24 hours following glucocorticoid administration was noted, but specific effect sizes for this biomarker were not reported.
The authors noted significant limitations, including heterogeneous interventions, varying timing, intervention dosage, and outcomes. The timing of assessment and biomarker profiling also varied across the included studies. Due to these factors, the overall quality of evidence was limited. The review supports the need for future trials to clarify the role of these agents in this population.
What this means for you:
This review found no clear benefit for immune drugs in heart attack survivors. More on Brain Injury
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View Original Abstract ↓
PURPOSE: To evaluate the effect of immunomodulatory therapeutics on mortality, neurological outcomes, and inflammatory biomarkers in patients resuscitated following cardiac arrest.
METHODS: Studies from MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were included from database inception up to June 2025. All randomized controlled trials using immunomodulators in adults following both in- and out-of-hospital cardiac arrest were included. Assessed outcomes included functional neurological outcome, mortality at 30 days, and inflammatory biomarkers levels. We pooled estimates of effect size using random effect model and report relative risks with 95% CI. We assessed risk of bias using the Cochrane Risk of Bias 2 tool and rated the certainty of evidence using GRADE methodology.
RESULTS: The search yielded 19,558 studies of which 2351 were duplicates. Fifty-eight full texts were reviewed and 11 studies plus 3 sub-studies was included for a total of 2605 patients. Of these clinical trials, immunomodulatory interventions consisted of corticosteroids (82%), interleukin-6 receptor blockade (9%), and calcineurin inhibition (9%). Immunomodulatory therapies were not associated with an increase in favorable neurological outcome (RR1.04 [0.85, 1.28]) nor a decrease in mortality (RR0.97 [0.91, 1.03]). A trend toward decreased IL-6 levels at 24 h following glucocorticoid administration was observed. The overall quality of evidence was limited by heterogeneous interventions and timing.
CONCLUSION: Across all studies, immunomodulating therapies were not associated with significant increases in favorable neurologic outcomes or survival. Between-study heterogeneity in intervention dosage, outcomes, timing of assessment, and biomarker profiling limited direct comparison and supports the need for future trials. Prospero registration: CRD420251068980.
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