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Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation

Kobi Ludwin, Kamil Safiejko, Jacek Smereka, Klaudiusz Nadolny, Maciej Cyran, Ruslan Yakubtsevich, Milosz J. Jaguszewski, Krzysztof J. Filipiak, Lukasz Szarpak, Antonio Rodríguez-Núñez
DOI: 10.5603/CJ.a2020.0133
·
Pubmed: 33140398

open access

Ahead of print
Original articles
Published online: 2020-10-22

Abstract

Background: There is a beneficial effect of adrenaline during adult cardiopulmonary resuscitation (CPR) from cardiac arrest but there is also uncertainty about its safety and effectiveness. The aim of this study was to evaluate the use of adrenaline versus non-adrenaline CPR.

Methods: PubMed, ScienceDirect, Embase, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases were searched from their inception up to 1st July 2020. Two reviewers independently assessed eligibility and risk of bias, with conflicts resolved by a third reviewer. Risk ratio (RR) or mean difference of groups were calculated using fixed or random-effect models.

Results: Nineteen trials were identified. The use of adrenaline during CPR was associated with a significantly higher percentage of return of spontaneous circulation (ROSC) compared to non-adrenaline treatment (20.9% vs. 5.9%; RR = 1.87; 95% confidence interval [CI] 1.37–2.55; p < 0.001). The use of adrenaline in CPR was associated with ROSC at 19.4% and for non-adrenaline treatment –4.3% (RR = 3.23; 95% CI 1.89–5.53; p < 0.001). Survival to discharge (or 30-day survival) when using adrenaline was 6.8% compared to non-adrenaline treatment (5.5%; RR = 0.99; 95% CI 0.76–1.30; p = 0.97). However, the use of adrenaline was associated with a worse neurological outcome (1.6% vs. 2.2%; RR = 0.57; 95% CI 0.42–0.78; p < 0.001).

Conclusions: This review suggests that resuscitation with adrenaline is associated with the return of spontaneous circulation and survival to hospital discharge, but no higher effectiveness was observed at discharge with favorable neurological outcome. The analysis showed higher effectiveness of ROSC and survival to hospital discharge in non-shockable rhythms. But more multicenter randomized controlled trials are needed in the future.

Abstract

Background: There is a beneficial effect of adrenaline during adult cardiopulmonary resuscitation (CPR) from cardiac arrest but there is also uncertainty about its safety and effectiveness. The aim of this study was to evaluate the use of adrenaline versus non-adrenaline CPR.

Methods: PubMed, ScienceDirect, Embase, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases were searched from their inception up to 1st July 2020. Two reviewers independently assessed eligibility and risk of bias, with conflicts resolved by a third reviewer. Risk ratio (RR) or mean difference of groups were calculated using fixed or random-effect models.

Results: Nineteen trials were identified. The use of adrenaline during CPR was associated with a significantly higher percentage of return of spontaneous circulation (ROSC) compared to non-adrenaline treatment (20.9% vs. 5.9%; RR = 1.87; 95% confidence interval [CI] 1.37–2.55; p < 0.001). The use of adrenaline in CPR was associated with ROSC at 19.4% and for non-adrenaline treatment –4.3% (RR = 3.23; 95% CI 1.89–5.53; p < 0.001). Survival to discharge (or 30-day survival) when using adrenaline was 6.8% compared to non-adrenaline treatment (5.5%; RR = 0.99; 95% CI 0.76–1.30; p = 0.97). However, the use of adrenaline was associated with a worse neurological outcome (1.6% vs. 2.2%; RR = 0.57; 95% CI 0.42–0.78; p < 0.001).

Conclusions: This review suggests that resuscitation with adrenaline is associated with the return of spontaneous circulation and survival to hospital discharge, but no higher effectiveness was observed at discharge with favorable neurological outcome. The analysis showed higher effectiveness of ROSC and survival to hospital discharge in non-shockable rhythms. But more multicenter randomized controlled trials are needed in the future.

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Keywords

adrenaline, epinephrine, cardiac arrest, cardiopulmonary resuscitation, outcome, return of spontaneous circulation, meta-analysis, systematic review

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Title

Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-10-22

DOI

10.5603/CJ.a2020.0133

Pubmed

33140398

Keywords

adrenaline
epinephrine
cardiac arrest
cardiopulmonary resuscitation
outcome
return of spontaneous circulation
meta-analysis
systematic review

Authors

Kobi Ludwin
Kamil Safiejko
Jacek Smereka
Klaudiusz Nadolny
Maciej Cyran
Ruslan Yakubtsevich
Milosz J. Jaguszewski
Krzysztof J. Filipiak
Lukasz Szarpak
Antonio Rodríguez-Núñez

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