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

@article{Vargas2019EpinephrineFO,
  title={Epinephrine for out of hospital cardiac arrest: a systematic review and meta-analysis of randomized controlled trials.},
  author={Maria Vargas and Pasquale Buonanno and Carmine Iacovazzo and Giuseppe Servillo},
  journal={Resuscitation},
  year={2019}
}
Effects of epinephrine for out-of-hospital cardiac arrest
TLDR
In this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.
Interventions to improve cardiopulmonary resuscitation: a review of meta-analyses and future agenda
TLDR
The available evidence suggests that the authors have a dearth of interventions that improve survival rates at hospital discharge and, even less so, neurological outcomes, and one can try to supplement the evidence gap with observational datasets, but this is unlikely that observational data will be sufficiently error-free to be conclusive.
Targeted temperature management guided by the severity of hyperlactatemia for out-of-hospital cardiac arrest patients: a post hoc analysis of a nationwide, multicenter prospective registry
TLDR
In OHCA patients with severe hyperlactatemia, the adjusted predicted probability of a 30-day favorable neurological outcome was greater with TTM at 32–34 °C than with T TM at 35–36 °Cs, and the differences in outcomes were not significant.
The fight against time in prehospital cardiac arrest
Background: The chances of survival after an out-of-hospital cardiac arrest (OHCA) are one in ten. The majority of survivors have no or relatively mild neurological sequelae. Interventions are time
Decreasing the Stress of Medication Management During Cardiac Arrest.
TLDR
Having a baseline understanding of the medications being used, routes of administration, and special considerations can be helpful in mitigating some of the stress in these situations of cardiac arrest.
Mortality in OHCA during resuscitation by rescue teams without a doctor
INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a condition that requires immediate intervention by a medical emergency team. CPR is usually based on current scientific guidelines. In Poland,
Update on Cardiopulmonary Resuscitation in Small Animals.
TLDR
The current guidelines on the treatment of small animals with CPA are summarized, including preparedness and prevention measures, basic and advanced life support as well as post-cardiac arrest care.

References

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TLDR
Epinephrine use during cardiac arrest is not associated with improved survival to hospital discharge and Observational studies with a lower-risk for bias suggest that it may be associated with decreased survival.
Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials.
TLDR
There was no benefit of adrenaline in survival to discharge or neurological outcomes, and there were improved rates of survival to admission and ROSC with SDA over placebo and HDA over SDA.
A Randomized Trial of Epinephrine in Out‐of‐Hospital Cardiac Arrest
TLDR
In adults with out‐of‐hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30‐day survival than theUse of placebo, but there was no significant between‐group difference in the rate of a favorable neurologic outcome.
Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial.
TLDR
Patients receiving adrenaline during cardiac arrest had no statistically significant improvement in the primary outcome of survival to hospital discharge although there was a significantly improved likelihood of achieving ROSC.
Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis
TLDR
Prehospital adrenaline administration may increase prehospital return of spontaneous circulation, but it does not improve overall rates of return of spontaneously circulation, hospital admission and survival to discharge.
Efficacy of vasopressin‐epinephrine compared to epinephrine alone for out of hospital cardiac arrest patients: A systematic review and meta‐analysis
TLDR
According to the pooled results of the subgroup, combination of vasopressin and adrenaline can improve ROSC of OHCA from Asia, but patients from other regions who suffered from OHCA cannot benefit from combination of Vasopress in and epinephrine.
Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation
TLDR
A significantly larger proportion of patients created with vasopressin than of those treated with epinephrine were resuscitated successfully from out-of-hospital ventricular fibrillation and survived for 24 h.
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TLDR
Compared with patients who received ACLS without intravenous drug administration following out-of-hospital cardiac arrest, patients with intravenous access and drug administration had higher rates of short-term survival with no statistically significant improvement in survival to hospital discharge, quality of CPR, or long- term survival.
A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest.
TLDR
High-dose epinephrine significantly improves the rate of return of spontaneous circulation and hospital admission in patients who are in prehospital cardiac arrest without increasing complications, and the increase in hospital discharge rate is not statistically significant, and no significant trend could be determined for neurological outcome.
A Comparison of Repeated High Doses and Repeated Standard Doses of Epinephrine for Cardiac Arrest Outside the Hospital
TLDR
A prospective, multicenter, randomized study comparing repeated high doses of epinephrine with repeated standard doses in cases of out-of-hospital cardiac arrest, which showed a return of spontaneous circulation in the high-dose group.
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