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Meta-Analysis
. 2020 Jun 2;9(11):e014330.
doi: 10.1161/JAHA.119.014330. Epub 2020 May 22.

Early Administration of Adrenaline for Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Liyu Ran  1   2 , Jinglun Liu  3 , Hideharu Tanaka  4 , Michael W Hubble  5 , Takyu Hiroshi  4 , Wei Huang  2
Affiliations
Meta-Analysis

Early Administration of Adrenaline for Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Liyu Ran et al. J Am Heart Assoc. .

Abstract

Background The use of adrenaline in out-of-hospital cardiac arrest (OHCA) patients is still controversial. This study aimed to determine the effects of early pre-hospital adrenaline administration in OHCA patients. Methods and Results PubMed, EMBASE, Google Scholar, and the Cochrane Library database were searched from study inception to February 2019 to identify studies that reported OHCA patients who received adrenaline. The primary outcome was survival to discharge, and the secondary outcomes were return of spontaneous circulation, favorable neurological outcome, and survival to hospital admission. A total of 574 392 patients were included from 24 studies. The use of early pre-hospital adrenaline administration in OHCA patients was associated with a significant increase in survival to discharge (risk ratio [RR], 1.62; 95% CI, 1.45-1.83; P<0.001) and return of spontaneous circulation (RR, 1.50; 95% CI, 1.36-1.67; P<0.001), as well as a favorable neurological outcome (RR, 2.09; 95% CI, 1.73-2.52; P<0.001). Patients with shockable rhythm cardiac arrest had a significantly higher rate of survival to discharge (RR, 5.86; 95% CI, 4.25-8.07; P<0.001) and more favorable neurological outcomes (RR, 5.10; 95% CI, 2.90-8.97; P<0.001) than non-shockable rhythm cardiac arrest patients. Conclusions Early pre-hospital administration of adrenaline to OHCA patients might increase the survival to discharge, return of spontaneous circulation, and favorable neurological outcomes. Registration URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42019130542.

Keywords: adrenaline; early pre‐hospital administration; out‐of‐hospital cardiac arrest.

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Figures

Figure 1
Figure 1. Flow diagram of the study selection.
Figure 2
Figure 2. Effects of early (<10 minutes vs >10 minutes) pre‐hospital adrenaline administration on survival to discharge/1 month.
RR indicates risk ratio.
Figure 3
Figure 3. Forest plot for pooling the effects of early (<10 minutes vs >10 minutes) pre‐hospital adrenaline administration on return of spontaneous circulation.
ROSC indicates return of spontaneous circulation; and RR, risk ratio.
Figure 4
Figure 4. Forest plot for pooling the effects of early (<10 minutes vs >10 minutes) pre‐hospital adrenaline administration on achieving a cerebral performance category of 1 to 2.
CPC indicates cerebral performance category; and RR, risk ratio.
Figure 5
Figure 5. A, Forest plot comparing survival to discharge between patients who had shockable and non‐shockable rhythm cardiac arrest; B, Forest plot comparing return of spontaneous circulation between patients who had shockable and non‐shockable rhythm cardiac arrest.
ROSC indicates return of spontaneous circulation; and RR, risk ratio.
Figure 6
Figure 6. A, Forest plot comparing the effects of a cerebral performance category of 1 to 2 between patients who had shockable and non‐shockable rhythm cardiac arrest;
B, Forest plot comparing survival to admission between patients who had shockable and non‐shockable rhythm cardiac arrest. RR indicates risk ratio.
See this image and copyright information in PMC

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