OPEN IN READ APP
JOURNAL ARTICLE
REVIEW

Epinephrine for out of hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials

Vargas Maria, Buonanno Pasquale, Iacovazzo Carmine, Servillo Giuseppe
Resuscitation 2019, 136: 54-60
30685547

OBJECTIVE: To evaluate the effectiveness of epinephrine, compared with control treatments, on survival at admission, ROSC, survival at discharge, and a favorable neurologic outcome in adult patients during OHCA.

DATA SOURCE: MEDLINE and PubMed from inception to August 2018.

STUDY SELECTION: Randomized controlled trials (RCTs) on adult patients after OHCA treated with epinephrine versus controls.

DATA EXTRACTION: Independent, double-data extraction; risk of bias assessment with Cochrane Collaboration's criteria.

DATA SYNTHESIS: 15 RCTs representing 20 716 OHCA adult patients. Epinephrine, compared with all pooled treatments, was associated with a better survival rate to hospital discharge (RR: 1.16, 95% CI: 1.00-1.35) and a favorable neurologic outcome (RR: 1.24, 95% CI: 1.04-1.48). No difference was found in survival to hospital admission (RR: 1.02, 95% CI: 0.75-1.38) and ROSC when comparing epinephrine with all pooled treatments (RR: 1.13, 95% CI: 0.84-1.53). When epinephrine was compared with a placebo/no drugs, survival to hospital discharge (RR: 1.34, 95% CI: 1.08-1.67), ROSC (RR: 2.03, 95% CI: 1.18-3.51) and survival to hospital admission (RR: 2.04, 95% CI: 1.22-3.43) were increased, but there was not a favorable neurologic outcome (RR: 1.22, 95% CI: 0.99-1.51).

CONCLUSIONS: In OHCA, standard or high doses of epinephrine should be used because they improved survival to hospital discharge and resulted in a meaningful clinical outcome. There was also a clear advantage of using epinephrine over a placebo or no drugs in the considered outcomes.

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
30685547
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"