Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation

Abstract

Background: There is a beneficial effect of adrenaline during adult cardiopulmonary resuscitation (CPR) from cardiac arrest but there is also uncertainty about its safety and effectiveness. The aim of this study was to evaluate the use of adrenaline versus nonadrenaline CPR. Methods: PubMed, ScienceDirect, Embase, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases were searched from their inception up to 1 st July 2020. Two reviewers independently assessed eligibility and risk of bias, with conflicts resolved by a third reviewer. Risk ratio (RR) or mean difference of groups were calculated using fixed or random-effect models. Results: Nineteen trials were identified. The use of adrenaline during CPR was associated with a significantly higher percentage of return of spontaneous circulation (ROSC) compared to non-adrenaline treatment (20.9% vs. 5.9%; RR = 1.87; 95% confidence interval [CI] 1.37-2.55; p < 0.001). The use of adrenaline in CPR was associated with ROSC at 19.4% and for non-adrenaline treatment-4.3% (RR = 3.23; 95% CI 1.89-5.53; p < 0.001). Survival to discharge (or 30-day survival) when using adrenaline was 6.8% compared to non-adrenaline treatment (5.5%; RR = 0.99; 95% CI 0.76-1.30; p = 0.97). However, the use of adrenaline was associated with a worse neurological outcome (1.6% vs. 2.2%; RR = 0.57; 95% CI 0.42-0.78; p < 0.001). Conclusions: This review suggests that resuscitation with adrenaline is associated with the return of spontaneous circulation and survival to hospital discharge, but no higher effectiveness was observed at discharge with favorable neurological outcome. The analysis showed higher effectiveness of ROSC and survival to hospital discharge in non-shockable rhythms. But more multicenter randomized controlled trials are needed in the future.

A Narrative Review of Drug Therapy in Adult and Pediatric Cardiac Arrest

“…Despite its benefits, epinephrine may also cause harm [ 50 , 51 , 52 , 53 ]. Epinephrine improves CPP but also increases vascular resistance by its 1 effect, leading to lower coronary flow despite higher CPPs [ 47 ].…”

Therapeutic and adverse effects of adrenaline on patients who suffer out-of-hospital cardiac arrest: a systematic review and meta-analysis

“…The results showed that CA patients' survival rates and outcomes improved when epinephrine was administered, but there was no subgroup analysis on different initial cardiac rhythms included. Based on a recent meta-analysis, epinephrine improved ROSC rates and survival rate of leave hospital in CA patients but worsened the neurological prognosis of OHCA patients [ 14 ]. The original literature included in this meta-analysis did not limit the population characteristics, but contained CA patients both in-hospital and out-of-hospital into the study; Prognostic factors, such as age, co-morbidity, etiology, and initial cardiac rhythms, were different in patients with in-hospital cardiac arrest (IHCA) and OHCA.…”

Is epinephrine still the drug of choice during cardiac arrest in the emergency department of the hospital? A meta-analysis

“…In their review article, Wyer et al (25) stated that epinephrine is more useful than vasopressin because it ensures a higher proportion of survivability to hospital discharge and more favorable neurological outcomes. In their systematic reviews and meta-analyses, the research groups led by Ludwin, Srisurapanont and Morales-Cane (26)(27)(28) reported that with a higher rate of spontaneous circulation and longer survival after cardiopulmonary resuscitation (CPR), epinephrine/adrenaline is the medication of choice for adults as compared to other drugs like vasopressin, atropine, etc. Similarly, Lundin, Gallimore and Papastylianou with their co-workers (29)(30)(31) in their review studies pointed to epinephrine/adrenaline as a useful medication in the treatment of cardiac arrest.…”