Maria Vargas1, Pasquale Buonanno2, Carmine Iacovazzo2, Giuseppe Servillo3. 1. Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy. Electronic address: vargas.maria82@gmail.com. 2. Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy. 3. Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy; Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Mediterraneo, Neuromed, Pozzilli, Italy.
Abstract
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.
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.
Authors: Melanie Smith Condeni; Alyson T Basting; Patrick G Costello; Ashley DePriest; Evert A Eriksson; Heather Evans; Kristie Hertel; Andre L Holder; Alyssa N Kester; Kinsey R Kowalski; Carolyn Magee Bell; Barbara McLean; Michael Reichert; Melissa Santibañez; Patrick M Wieruszewski; Andrea Sikora Newsome Journal: J Crit Care Date: 2020-12-27 Impact factor: 3.425