Epinephrine in cardiac arrest: systematic review and meta-analysis

Abstract

Objective:evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method:systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results:when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion:administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status.

Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies

“…Two previous meta-analyses [ 26 , 27 ] indicated that IO access was associated with worse OHCA outcomes, compared with IV access. In Morales-Cané et al study [ 26 ], the synthesized OR from three studies [ 18 – 20 ] indicated significant association between IO access and lower survival at hospital discharge ( I 2 , 30%).…”

“…Two previous meta-analyses [ 26 , 27 ] indicated that IO access was associated with worse OHCA outcomes, compared with IV access. In Morales-Cané et al study [ 26 ], the synthesized OR from three studies [ 18 – 20 ] indicated significant association between IO access and lower survival at hospital discharge ( I 2 , 30%). Subsequently, after adding the study by Zhang et al [ 25 ] to the previous results [ 26 ], Granfeldt et al [ 27 ] indicated that IO access was not only associated with lower survival ( I 2 , 71%) but also worse neurological outcome at hospital discharge ( I 2 , 89%), though the heterogeneity of this expanded meta-analysis increased substantially.…”

Parada cardiorrespiratória pré-hospitalar: avaliação dos atendimentos segundo o utstein style*

“…It is emphasized, according to the latest recommendation, published in 2019, that the administration of epinephrine should occur as soon as possible in non-shockable rhythms and, when it is a shockable rhythm, the drug should be applied only after the first attempt at defibrillation if unsuccessful and vasopressin is not recommended. 18 In two recent systematic reviews, it was found that there are benefits to the administration of epinephrine in the return of spontaneous circulation during resuscitation maneuvers, as well as an increase in survival at hospital discharge [19][20] and after 30 days when administered epinephrine within ten minutes compared to late application 19 and also after three months. 20 Amiodarone use was reported to have been reported in 30 (18.4%) consultations, being the drug of choice when there is a shockable rhythm detected, according to the 2015 recommendation 5 ; however, this number does not correspond to the number of shockable rhythms found -17 (10.4%) -nor to the number of patients receiving defibrillation, which was 41 (25.2%).…”

Automated external defibrillators in the hospital: A case of medical reversal

“…Prasad and Cifu say that too frequently "[t]he contradicted practice does not stop immediately…[but] continues for years to come" [28]. ECC Guidelines may remain in place for decades despite thin or nonexistent evidence for adoption and the subsequent publication of negative studies [20,29]. Systems interventions may be especially hard to reverse due to entrenched financial and/or intellectual interests [18].…”