Takeaway
- For patients experiencing out-of-hospital cardiac arrest (OHCA), epinephrine in standard or high doses is tied to better short-term outcomes at hospital discharge, but not neurological outcomes.
Why this matters
- Optimal epinephrine dosage during OHCA resuscitation is unknown.
- This meta-analysis compares epinephrine vs placebo/no drugs, stratifies trials by fragility, and includes PARAMEDIC2.
Key results
- Survival to discharge:
- Standard-dose epinephrine (SDE) vs placebo/no drugs: relative risk (RR), 1.34 (95% CI, 1.08-1.67; P=.00).
- Similar results in robust vs nonrobust trials.
- SDE vs high-dose epinephrine (HDE) or SDE vs epinephrine+vasopressin: no difference.
- Return of spontaneous circulation:
- SDE vs placebo/no drugs: RR, 2.03 (95% CI, 1.18-3.51; P=.01).
- SDE vs HDE: RR, 0.85 (95% CI, 0.74-0.97; P=.01).
- Survival to admission:
- SDE vs placebo/no drugs: RR, 2.04 (95% CI, 1.22-3.43; P=.00).
- SDE vs HDE: RR, 0.86 (95% CI, 0.75-0.99; P=.04).
- No comparator led to better neurological outcomes.
Study design
- Systematic review, meta-analysis of 15 randomised controlled trials (n=20,716).
- Trials assessed epinephrine vs placebo or no drugs for treatment of adult OHCA.
- Outcome: survival to hospital discharge.
- Funding: None.
Limitations
- Prospective and retrospective studies excluded.
- Fragility index exceeded 0 in only 3 trials, suggesting that only a few patients with different outcomes would have changed the conclusions.
References
References