Adrenaline looks useful in cardiac arrest, but vasopressin is uncertain: Cochrane

  • Finn J & al.
  • Cochrane Database Syst Rev
  • 17 Jan 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For patients experiencing cardiac arrest, this meta-analysis found moderate-quality evidence for survival advantage with standard-dose adrenaline (SDA or epinephrine) vs placebo.

Why t his matters

  • Safety, efficacy, and optimal dosages, if any, remain unclear.

Key results

  • SDA vs placebo (all values risk ratios, 95% CIs):
    • Survival to hospital discharge (STHD):
      • 1.44 (1.11-1.86; moderate-quality evidence).
    • Survival to hospital admission (STHA):
      • 2.51 (1.67-3.76; moderate-quality evidence).
    • Neurological outcome:
      • No difference.
    • Return of spontaneous circulation (ROSC):
      • 2.86 (2.21-3.71).
  • SDA vs high-dose adrenaline (HDA):
    • STHD:
      • No difference.
    • STHA:
      • 1.13 (1.03-1.24).
    • Neurological outcome:
      • No difference.
    • ROSC:
      • 1.15 (1.02-1.29).
  • SDA vs vasopressin: 
    • STHD:
      • No difference. 
    • STHA:
      • 1.27 (1.04-1.54).
    • Neurological outcome:
      • No difference.
    • ROSC:
      • No difference.
  • SDA vs vasopressin plus adrenaline:
    • No differences for the 4 outcomes.
  • Unless otherwise noted, evidence quality was low or very low.

Study design

  • Systematic review and meta-analysis of 26 randomized controlled trials comparing adrenaline vs placebo; SDA vs HDA; or adrenaline vs vasopressin or combination therapy in patients of any age experiencing cardiac arrest of any etiology and location (n=21,704).
  • Outcomes: STHD; STHA; neurological outcome.
  • Funding: Australian Resuscitation Council.

Limitations

  • Most trials addressed adults with out-of-hospital cardiac arrest.

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