Effects of epinephrine for out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials

Abstract

Aim: Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest.

Background: Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes.

Method: Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test.

Result: In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001).

Conclusion: In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.

Figure 1

Flow diagram showing the selection of randomized controlled trials.

Figure 2

Risk bias of graph. Each risk of bias item presented as percentages across all of the included trials, which indicated the proportion of different level risk of bias for each item.

Figure 3

Risk bias of summary. Judgments about each risk of bias item for each included trials. Green indicates low risk of bias. Yellow indicates unclear risk of bias. Red indicates high risk of bias.

Figure 4

Forest plots of survival to discharge in patients with epinephrine therapy vs those without epinephrine administration for OHCA.

Figure 5

A analysis of individual study was to confirm the influence of each study for the result, all the spots located in 95% CI.

Figure 6

Forest plots of ROSC suggested Patients receiving epinephrine were more over three times more likely to ROSC than those non-epinephrine administration.

Figure 7

Forest plots of CPC 1 or 2 in patients with epinephrine vs those without epinephrine administration for OHCA demonstrated there was no significant difference between the two groups.

Figure 8

Forest plots of hospital admission suggested that the effect of epinephrine highly varied across studies and it was not statistically valid with a pooled RR of 2.07.

Figure 9

The galbraith plot for heterogeneous was to find the sources of heterogeneity.