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

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.