Etomidate versus propofol sedation for electrical external cardioversion: a meta-analysis

Abstract

Objective: To compare the efficacy and safety of etomidate vs propofol sedation for electrical cardioversion.

Methods: The authors searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, Google Scholar, Koreamed, and KMBASE databases to identify all randomized controlled trials that compared etomidate and propofol sedation for cardioversion in adult patients. Induction and recovery time, success rate, number of shocks, and cumulative energy were evaluated. Adverse effects, including respiratory and cardiovascular complications, myoclonus, and nausea and vomiting, were also assessed.

Results: A total of nine studies, involving a total of 430 patients, were included. Induction and recovery time, success rate, number of shocks, and cumulative energy were similar. The incidences of hypotension and respiratory depression were significantly higher in the propofol group than in the etomidate group (risk ratio [RR] = 0.11, 95% confidence interval (CI) = 0.02–0.74, I² = 0%; RR = 0.50, 95% CI = 0.32–0.77, I² = 47%, respectively). The incidences of myoclonus and nausea or vomiting were significantly higher in the etomidate group than in the propofol group (RR = 8.89, 95% CI  =  4.59–17.23, I² = 9%; RR = 5.13, 95% CI = 1.72–15.31, I² = 31%, respectively).

Conclusions: Issues affecting efficacy, including induction and recovery time, success rate, number of shocks, and cumulative energy, were comparable between etomidate and propofol sedation. Regarding safety issues, propofol sedation resulted in hypotension and respiratory depression more frequently; however, initiation of positive pressure ventilation was comparable. Etomidate sedation caused myoclonus and nausea or vomiting more frequently.

Keywords:

• Electrical cardioversion
• Etomidate
• Meta-analysis
• Propofol
• Sedation

Transparency

Declaration of funding

This research was supported by the Basic Science Research Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Education, Science and Technology (NRF-2018R1A2A2A05021467).

Declaration of financial/other relationships

The authors have no conflicts of interest to disclose. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

No assistance in the preparation of this article is to be declared.