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

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, I-2 = 0%; RR = 0.50, 95% CI = 0.32-0.77, I-2 = 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, I-2 = 9%; RR = 5.13, 95% CI = 1.72-15.31, I-2 = 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.