Abstract
Introduction
Out of hospital cardiac arrest (OHCA) is a time critical and heterogeneous presentation.
The most appropriate management strategies remain an issue for debate. The aim of
this systematic review and meta-analysis was to determine the association of epinephrine
versus placebo with return of spontaneous circulation, survival to hospital admission,
survival to hospital discharge and neurological outcomes in out of hospital cardiac
arrest.
Methods
A systematic review of five databases was performed from inception to August 2018.
Only randomised controlled trials were considered eligible for inclusion. The primary
outcome was survival to hospital discharge. Secondary outcomes were ROSC, survival
to hospital admission, neurological function on discharge and three-month survival.
All studies were assessed for level of evidence and risk of bias.
Results
Five randomised controlled trials with 17,635 patients were identified for inclusion.
Use of epinephrine was associated with increased ROSC (OR = 3.10; 95% CI = 2.16 to
4.45; I2 = 74%; p < 0.0001) and increased survival to hospital admission OR = 2.52; 95% CI = 1.63 to
3.88; I2 = 94%; p < 0.0001). However, epinephrine was not associated with increased survival to discharge
(OR = 1.09; 95% CI = 0.48 to 2.47; I2 = 77%; p = 0.84) or differences in neurological outcomes (OR = 0.81; 95% CI = 0.34 to 1.96).
Discussion
This study was a systematic review and meta-analysis of epinephrine versus placebo
in OHCA. The use of epinephrine was associated with improved ROSC and survival to
hospital admission. However, use of epinephrine was not associated with a significant
difference in survival to hospital discharge, neurological outcomes or survival to
3 months. Further research is required to control for the confounders during inpatient
management.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
- Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.N Engl J Med. 2000; 343: 1206-1209
- Antiarrhythmics in cardiac arrest: a systematic review and meta-analysis.Heart Lung Circ. 2017; 27: 280-290
- Is adrenaline effective in out of hospital cardiac arrest?.BMJ. 2014; 348: g1763
- Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists.J Am Coll Cardiol. 2009; 53: 1320-1325
- Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation.Crit Care Med. 2009; 37: 1408-1415
- Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials.Resuscitation. 2014; 85: 732-740
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- Version 5.vol. 3. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen2014
- Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis.Crit Care. 2014; 18: 463
- Effect of epinephrine on survival after cardiac arrest: a systematic review and meta-analysis.Minerva Anestesiol. 2014; 80: 831-843
- Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial.Resuscitation. 2011; 82: 1138-1143
- Dynamic effects of adrenaline (epinephrine) in out-of-hospital cardiac arrest with initial pulseless electrical activity (PEA).Resuscitation. 2012; 83: 946-952
- Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.JAMA, J Am Med Assoc. 2009; 302: 2222-2229
- A randomized trial of epinephrine in out-of-hospital cardiac arrest.N Engl J Med. 2018; 379: 711-721
- High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest.Resuscitation. 1995; 30: 243-249
- Reliability of the Cerebral Performance Category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study.Scand J Trauma Resusc Emerg Med. 2011; 19: 38
- Association between cerebral performance category, modified Rankin scale, and discharge disposition after cardiac arrest.Resuscitation. 2011; 82: 1036-1040
- Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.N Engl J Med. 2002; 346: 549-556
- Resuscitation outcomes in consortium investigators. Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults.Circulation. 2018; 137: 2032-2040
Article Info
Publication History
Published online: January 11, 2019
Accepted:
December 27,
2018
Received in revised form:
December 24,
2018
Received:
August 24,
2018
Footnotes
☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
