Background Vasopressin (AVP) and terlipressin (TP) have been used as last line therapy in refractory shock in children. However, the efficacy and safety of AVP and TP were not determined these populations. We aimed to assess the efficacy and safety of AVP/TP in paediatric re-fractory shock.

Methods We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA). AVP and TP, were compared with conventional therapy. MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched up to February 2016. Reports of clinical trials were pooled using random-effects models and TSA. Main outcomes were mortality and tissue ischemia.

Results Three randomised control trials and five ‘be-fore-and-after clinical’ trials met the inclusion criteria. Among 224 neonates and children, with refractory shock, 152 received therapy with AVP or TP. Pooled analyses, showed no association between AVP/TP treatment and mortality (relative risk (RR),1.19; 95% CI, 0.71–2.00), length of stay in the paediatric intensive care department (PICU) (mean difference (MD), −3.58 days; 95% CI, (−9.05) −1.83) and events of tissue ischemia (RR, 1.48; 95% CI, 0.47–4.62). In TSA, no significant effect on mortality and developing tissue ischemia was observed with AVP/TP therapy.

Conclusion AVP/TP therapy was not associated with a decreased risk for mortality and for length of stay in PICU. Furthermore, in TSA, a trend for an association with an increased risk for ischaemic events was observed. Our study suggests that further large studies are necessary to demonstrate and establish benefits of AVP/TP in children.

PROSPERO registry-CRD42016035872