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

Kempton, H.; Vlok, Ruan; Thang, Christopher; Melhuish, Thomas; White, Leigh

doi:10.1016/j.ajem.2018.12.055

Cited by 17 publications

(14 citation statements)

References 17 publications

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“…Kempton et al performed a systematic review and meta-analysis of Ep versus placebo in patients with OHCA. They reported that the use of Ep was not associated with a significant difference in survival to hospital discharge, neurological outcomes, or 3-month survival [ 14 ]. Aves et al also performed an updated systematic review and meta-analysis of clinical trials evaluating Ep for the resuscitation of adults with OHCA.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the Plasma Levels of Catecholamines and Return of Spontaneous Circulation in Patients with Out-of-Hospital Cardiac Arrest

Ichikawa

Sawada

Nakajima

et al. 2021

Emergency Medicine International

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Purpose. The dynamic state of epinephrine (Ep) in the plasma of patients with out-of-hospital cardiac arrest (OHCA) remains unclear. The purpose of this study was to evaluate the relationship between the plasma levels of catecholamines (such as epinephrine (Ep), norepinephrine (Nep), and dopamine) and vasopressin (antidiuretic hormone (ADH)) and the acquisition of return of spontaneous circulation (ROSC) in OHCA patients. Methods. This was a prospective, observational clinical study. Patients with OHCA transferred to our hospital between July 2014 and July 2017 were enrolled. The levels of catecholamines and ADH in the plasma were measured using blood samples immediately obtained on arrival at our hospital and before the administration of Ep. Patients in whom Ep was already administered prior to obtaining blood samples were excluded. Patients were divided into two groups: with and without ROSC, that is, ROSC (+) and ROSC (−) groups, respectively. The plasma levels of these agents and the conditions of resuscitation were compared between the two groups. Results. A total of 96 patients with OHCA were analyzed. The ROSC (+) and ROSC (−) groups included 34 and 62 patients, respectively. There were no significant differences observed between the two groups in age, cause of cardiopulmonary arrest, and prehospital resuscitation time. The plasma levels of Ep and Nep were significantly lower in the ROSC (+) group than in the ROSC (−) group. However, there were no significant differences in the plasma levels of dopamine and ADH between the two groups. Conclusion. Increased levels of Ep in the plasma may not be associated with the acquisition of ROSC in patients with OHCA.

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Section: Discussionmentioning

confidence: 99%

Relationship between the Plasma Levels of Catecholamines and Return of Spontaneous Circulation in Patients with Out-of-Hospital Cardiac Arrest

Ichikawa

Sawada

Nakajima

et al. 2021

Emergency Medicine International

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“…The second key parameter triggered by EE was post-resuscitation hypertension. Blood pressure is directly associated with vasoconstriction (α-agonist effect) and cardiac output (β-agonist effect) (14, 46, 47). Therefore, we suspected that early administration might maximize the dual effects (α and β agonist effects) of epinephrine and then ROSC would be easier to establish.…”

Section: Discussionmentioning

confidence: 99%

Early Epinephrine Improves the Stabilization of Initial Post-resuscitation Hemodynamics in Children With Non-shockable Out-of-Hospital Cardiac Arrest

Lin

Huang

et al. 2019

Front. Pediatr.

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Background: In children with non-shockable out-of-hospital cardiac arrest, early epinephrine (EE) might help to establish the return of spontaneous circulation (ROSC) and be associated with survival. In the present study, we aimed to analyze the effects of EE on outcomes and post-resuscitation hemodynamics in children with non-shockable OHCA. Methods: This was a retrospective analysis of data from 216 children (<19 years) who had suffered non-traumatic and non-shockable OHCA and received epinephrine for resuscitation (Jan 1, 2006–Dec 31, 2014). Demographics, pre-/in-hospital information, and the time to the first dose of epinephrine were recorded. Early post-resuscitation hemodynamics (the first hour after sustained ROSC), survival and good neurological outcomes (Pediatric Cerebral Performance Category Scales 1 or 2) were analyzed by the time to epinephrine—classified as early (EE): <15 min, intermediate (IE): 15–30 min, or late (LE): >30 min. Results: Twenty-eight (13.0%) children survived to discharge, but only 17 (7.9%) had good neurological outcomes. In all, 41 (18.9%) children received EE; in comparison to IE and LE, this was significantly associated with tachycardia (73.9%) in the post-resuscitation period ( p < 0.05). Tachycardia (OR: 7.41, 95% CI: 1.96–29.31) and hypertension (OR: 6.03, 95% CI: 1.85–13.77) were significantly associated with EE after adjusting for confounding factors. EE was also significantly associated with better overall outcomes than ME and LE (any ROSC, sustained ROSC, survival to the intensive care unit, admission, survival to discharge and good neurological outcomes, all p < 0.05). Conclusions: EE helped to establish ROSC but was also associated with more tachycardia and hypertension in the early post-resuscitation period. 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.

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“…This finding was consistent with other previous systematic reviews and meta-analyses. [19][20][21][22][23] Shao and his team concluded that the administration of epinephrine was associated with higher return of spontaneous circulation but no benefits on survival to hospital discharge or survival with favorable neurologic outcomes after OHCA. 22 Ng © 2019 Prehospital and Disaster Medicine However, these findings need to be interpreted with caveat due to the nature of observational studies, unadjusted confounding factor, and lack of randomization.…”

Section: Discussionmentioning

confidence: 99%

“…34 A recent review based on five RCTs with 17,635 patients demonstrated that the use of epinephrine was not associated with significant difference in survival to hospital discharge and neurologic prognosis at discharge. 23 This review has to be interpreted with cautions as it included three studies 8,34,35 with high-risk of bias and potential confounding factors, which increased the degree of heterogeneity. In the Olasveengen's study, the study design and methodology were fundamentally different as the intervention was based on the establishment of intravenous access by paramedics, and by default, administration of drugs (either intravenous epinephrine, atropine, or amiodarone) during resuscitation.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Prehospital Epinephrine in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Teoh

2019

Prehosp. Disaster med.

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Introduction:Epinephrine has been recommended for out-of-hospital cardiac arrest (OHCA) resuscitation for nearly one century, but its efficacy and safety remain unclear in the literature. The primary aim of this review was to determine whether epinephrine increases the return of spontaneous circulation in OHCA patients.Methods:A systematic review and meta-analysis were conducted using the following databases: MEDLINE, EMBASE, and CENTRAL, from their inception until October 2018. All the randomized controlled trials (RCTs) were included. Observational studies, case reports, case series, and non-systematic reviews were excluded.Results:Two trials including 8,548 patients were eligible for inclusion in the data synthesis. In patients who received epinephrine during OHCA, the incidence of return of spontaneous circulation was increased, with an odds ratio (95%CI) of 4.25 (3.79-4.75), P <.001, high-quality of evidence. The number of patients transported to hospital was increased in patients who had prehospital epinephrine, with an odds ratio (95%CI) of 2.31 (2.11-2.53), P <.001, high-quality of evidence. The prehospital use of epinephrine was associated with an increased survival to hospital discharge, the odds ratio (95%CI) being 1.43 (1.10-1.87), P = .008, moderate-quality of evidence. No significant effect was noted on the favorable neurologic state of patient at hospital discharge, with an odds ratio (95%CI) of 1.21 (0.90-1.64), P = .21, moderate-quality of evidence.Conclusions:This meta-analysis suggests 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. The general quality of evidence ranged from moderate to high.

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

Cited by 17 publications

References 17 publications

Relationship between the Plasma Levels of Catecholamines and Return of Spontaneous Circulation in Patients with Out-of-Hospital Cardiac Arrest

Relationship between the Plasma Levels of Catecholamines and Return of Spontaneous Circulation in Patients with Out-of-Hospital Cardiac Arrest

Early Epinephrine Improves the Stabilization of Initial Post-resuscitation Hemodynamics in Children With Non-shockable Out-of-Hospital Cardiac Arrest

The Effect of Prehospital Epinephrine in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

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