Standard dose epinephrine versus placebo in out of hospital cardiac arrest: A systematic review and meta‐analysis☆

  title={Standard dose epinephrine versus placebo in out of hospital cardiac arrest: A systematic review and meta‐analysis☆},
  author={Hannah R. Kempton and Ruan Vlok and Christopher Thang and Thomas Melhuish and Leigh White},
  journal={American Journal of Emergency Medicine},
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… Expand
The Effect of Prehospital Epinephrine in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis
It is suggested that the prehospital use of epinephrine increases return of spontaneous circulation, transport of patients to hospital, and survival to hospital discharge for OHCA, however, no significant effects on favorable neurologic function at hospital discharge were demonstrated. Expand
Drug use during adult advanced cardiac life support: An overview of reviews
An overview of systematic reviews and meta-analyses to summarize the ever-growing evidence on drug use during advanced life support finds lidocaine is a valuable alternative for amiodarone and maybe even preferable for shockable cardiac arrest, however more research is necessary. Expand
Early Epinephrine Improves the Stabilization of Initial Post-resuscitation Hemodynamics in Children With Non-shockable Out-of-Hospital Cardiac Arrest
In children with non-traumatic and non-shockable OHCA, EE was associated with a higher survival rate and better neurological outcomes than were ME and LE and was significantly associated with tachycardia and hypertension in the early post-resuscitation period. Expand
Influence of the prehospital administered dosage of epinephrine on the plasma levels of catecholamines in patients with out-of-hospital cardiac arrest
The prehospital administered dosage of epinephrine influences the plasma levels of Ep; however, it does not contribute to the Plasma levels of Nep, DOA and ADH in patients with OHCA. Expand
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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. Expand
Relationship between the Plasma Levels of Catecholamines and Return of Spontaneous Circulation in Patients with Out-of-Hospital Cardiac Arrest
Increased levels of Ep in the plasma may not be associated with the acquisition of ROSC in patients with OHCA, and there were no significant differences in the Plasma levels of dopamine and ADH between the two groups. Expand
Pharmacokinetic effects of endotracheal, intraosseous, and intravenous epinephrine in a swine model of traumatic cardiac arrest.
Epinephrine appeared to have a lesser role than volume replacement in resuscitating TCA, and the pharmacokinetics of IV, HIO, and SIO epinephrine were comparable. Expand
Ultra-early serum concentrations of neuronal and astroglial biomarkers predict poor neurological outcome after out-of-hospital cardiac arrest—a pilot neuroprognostic study☆
Ultra-early serial serum concentrations of neuronal and astroglial biomarkers may be of neuroprognostic significance following OHCA and four-marker score trajectory group memberships are in concordance with patient outcome. Expand
Adrenaline improves regional cerebral blood flow, cerebral oxygenation and cerebral metabolism during CPR in a porcine cardiac arrest model using low-flow extracorporeal support.
This study shows that adrenaline administration during constant low systemic blood flow increases CePP, regional CBF, cerebral oxygenation and cerebral metabolism and that MAP of 60 mmHg was associated with metabolic improvement. Expand


Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials.
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. Expand
Effect of epinephrine on survival after cardiac arrest: a systematic review and meta-analysis.
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. Expand
A Randomized Trial of Epinephrine in Out‐of‐Hospital Cardiac Arrest
  • G. Perkins, Chen Ji, +21 authors R. Lall
  • Medicine
  • The New England journal of medicine
  • 2018
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. Expand
Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial.
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. Expand
Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis
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. Expand
Predictors of Survival From Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis
Overall survival from OHCA has been stable for almost 30 years, as have the strong associations between key predictors and survival, and efforts to improve survival should focus on prompt delivery of interventions of known effectiveness by those who witness the event. Expand
Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.
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. Expand
High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest.
Analysis of rhythm changes resulting from the dosing showed a significant (P = 0.01) change to a beneficial rhythm with 10 mg adrenaline but not for 1 mg adrenaline or placebo, and this was not reflected by an improvement in immediate survival. Expand
Time to Epinephrine Administration and Survival From Nonshockable Out-of-Hospital Cardiac Arrest Among Children and Adults
Among OHCAs with nonshockable initial rhythms, the majority of patients were administered epinephrine >10 minutes after EMS arrival, and each minute delay in epinphrine administration was associated with decreased survival and unfavorable neurological outcomes. Expand
Antiarrhythmics in Cardiac Arrest: A Systematic Review and Meta-Analysis.
This systematic review and meta-analysis suggests that, based on current literature and data, there has been no conclusive evidence that any antiarrhythmic agents improve rates of ROSC, survival to admission, Survival to discharge or neurological outcomes. Expand