Thursday, February 03, 2005

The last gulp of "Sodi water" ? Once again a large RCT trumps a meta-analysis

As early as the mid 1960's an infusion of glucose, insulin and potassium was being used to treat myocardial infarctions having been introduced by Dr Demetri Sodi-Pollares.Over the years a number of small clinical trials seem to indicate the value of this "polarizing solution" that-at least when I was a house office- was known as sodi water.Also a meta-analysis indicated its efficacy. Now a very large (n=20,201)RCT has shown it to be of no value some 40 years after its introduction.
The CREATE-ECLA RCT was conducted in 470 centers through out the world and showed no difference in mortality,cardiac arrest or shock in patients with STEMI treated with the GIK solution.
Once again a large RCT provided results contrary to an earlier meta-analysis.Why does this happen? The usual suspects are: publication bias and poor methodology in some of the trials included in the meta-analysis.Adding up a number of questionable trials does not equal one large well done trial.

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