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

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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.

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Most cited references 43

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A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest

Kyee Han, Nigel Stallard, Stavros Petrou … (2018)

Concern about the use of epinephrine as a treatment for out-of-hospital cardiac arrest led the International Liaison Committee on Resuscitation to call for a placebo-controlled trial to determine whether the use of epinephrine is safe and effective in such patients.

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Nationwide public-access defibrillation in Japan.

Taku Iwami, Ken Nagao, Tetsuhisa Kitamura … (2010)

It is unclear whether dissemination of automated external defibrillators (AEDs) in public places can improve the rate of survival among patients who have had an out-of-hospital cardiac arrest. From January 1, 2005, through December 31, 2007, we conducted a prospective, population-based, observational study involving consecutive patients across Japan who had an out-of-hospital cardiac arrest and in whom resuscitation was attempted by emergency responders. We evaluated the effect of nationwide dissemination of public-access AEDs on the rate of survival after an out-of-hospital cardiac arrest. The primary outcome measure was the 1-month rate of survival with minimal neurologic impairment. A multivariate logistic-regression analysis was performed to assess factors associated with a good neurologic outcome. A total of 312,319 adults who had an out-of-hospital cardiac arrest were included in the study; 12,631 of these patients had ventricular fibrillation and had an arrest that was of cardiac origin and that was witnessed by bystanders. In 462 of these patients (3.7%), shocks were administered by laypersons with the use of public-access AEDs, and the proportion increased, from 1.2% to 6.2%, as the number of public-access AEDs increased (P<0.001 for trend). Among all patients who had a bystander-witnessed arrest of cardiac origin and who had ventricular fibrillation, 14.4% were alive at 1 month with minimal neurologic impairment; among patients who received shocks from public-access AEDs, 31.6% were alive at 1 month with minimal neurologic impairment. Early defibrillation, regardless of the type of provider (bystander or emergency-medical-services personnel), was associated with a good neurologic outcome after a cardiac arrest with ventricular fibrillation (adjusted odds ratio per 1-minute increase in the time to administration of shock, 0.91; 95% confidence interval, 0.89 to 0.92; P<0.001). The mean time to shock was reduced from 3.7 to 2.2 minutes, and the annual number of patients per 10 million population who survived with minimal neurologic impairment increased from 2.4 to 8.9 as the number of public-access AEDs increased from fewer than 1 per square kilometer of inhabited area to 4 or more. Nationwide dissemination of public-access AEDs in Japan resulted in earlier administration of shocks by laypersons and in an increase in the 1-month rate of survival with minimal neurologic impairment after an out-of-hospital cardiac arrest. 2010 Massachusetts Medical Society

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Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial.

John L P Thompson, J Finn, Heidi Jacobs … (2011)

There is little evidence from clinical trials that the use of adrenaline (epinephrine) in treating cardiac arrest improves survival, despite adrenaline being considered standard of care for many decades. The aim of our study was to determine the effect of adrenaline on patient survival to hospital discharge in out of hospital cardiac arrest. We conducted a double blind randomised placebo-controlled trial of adrenaline in out-of-hospital cardiac arrest. Identical study vials containing either adrenaline 1:1000 or placebo (sodium chloride 0.9%) were prepared. Patients were randomly allocated to receive 1 ml aliquots of the trial drug according to current advanced life support guidelines. Outcomes assessed included survival to hospital discharge (primary outcome), pre-hospital return of spontaneous circulation (ROSC) and neurological outcome (Cerebral Performance Category Score - CPC). A total of 4103 cardiac arrests were screened during the study period of which 601 underwent randomisation. Documentation was available for a total of 534 patients: 262 in the placebo group and 272 in the adrenaline group. Groups were well matched for baseline characteristics including age, gender and receiving bystander CPR. ROSC occurred in 22 (8.4%) of patients receiving placebo and 64 (23.5%) who received adrenaline (OR=3.4; 95% CI 2.0-5.6). Survival to hospital discharge occurred in 5 (1.9%) and 11 (4.0%) patients receiving placebo or adrenaline respectively (OR=2.2; 95% CI 0.7-6.3). All but two patients (both in the adrenaline group) had a CPC score of 1-2. Patients receiving adrenaline during cardiac arrest had no statistically significant improvement in the primary outcome of survival to hospital discharge although there was a significantly improved likelihood of achieving ROSC. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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Author and article information

Contributors

Wei Huang:

ORCID: https://orcid.org/0000-0002-2707-2165

weihuangcq@gmail.com

Journal

Journal ID (nlm-ta): J Am Heart Assoc

Journal ID (iso-abbrev): J Am Heart Assoc

Journal ID (doi): 10.1002/(ISSN)2047-9980

Journal ID (publisher-id): JAH3

Journal ID (hwp): ahaoa

Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2047-9980

Publication date (Electronic): 04 June 2020

Publication date Collection: 02 June 2020

Volume: 9

Issue: 11 ( doiID: 10.1002/jah3.v9.11 )

Electronic Location Identifier: e014330

Affiliations

[ ¹ ] Department of Orthopaedic Surgery and Orthopaedics Research Institute West China Hospital Sichuan University Chengdu China

[ ² ] Department of Cardiology First Affiliated Hospital Chongqing Medical University Chongqing China

[ ³ ] Department of Emergency Medicine and Critical Care Medicine The First Affiliated Hospital of Chongqing Medical University Chongqing China

[ ⁴ ] Department of EMS System Graduate School Kokushikan University Tokyo Japan

[ ⁵ ] Emergency Medical Science Department Wake Technical Community College Raleigh NC

Author notes

[*] [* ]Correspondence to: Wei Huang, MD, PhD, Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. E‐mail: weihuangcq@ 123456gmail.com

Author information

Wei Huang https://orcid.org/0000-0002-2707-2165

Article

Publisher ID: JAH35134

DOI: 10.1161/JAHA.119.014330

PMC ID: 7429014

PubMed ID: 32441184

SO-VID: 0ea3d270-8abd-4bac-94de-4aba8c80403b

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 19 August 2019

Date accepted : 08 April 2020

Page count

Figures: 6, Tables: 1, Pages: 25, Words: 6238

Funding

Funded by: National Natural Science Foundation of China , open-funder-registry 10.13039/501100001809;

Award ID: 81170188

Award ID: 30971212

Custom metadata

source-schema-version-number 2.0

cover-date 02 June 2020

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.5 mode:remove_FC converted:19.07.2020

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: adrenaline,early pre‐hospital administration,out‐of‐hospital cardiac arrest,cardiopulmonary arrest,cardiopulmonary resuscitation and emergency cardiac care

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: adrenaline, early pre‐hospital administration, out‐of‐hospital cardiac arrest, cardiopulmonary arrest, cardiopulmonary resuscitation and emergency cardiac care

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

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Abstract

Background

Methods and Results

Conclusions

Registration

Related collections

Karger: Cardiovascular System

Most cited references 43

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest

Nationwide public-access defibrillation in Japan.

Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial.

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Contributors

Journal

Affiliations

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Cited by 13

Most referenced authors 1,287