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

Abstract Objective To evaluate the effectiveness of epinephrine, compared with control treatments, on survival at admission, ROSC, survival at discharge, and a favorable neurologic outcome in adult patients during OHCA. Data source MEDLINE and PubMed from inception to August 2018. Study selection Randomized controlled trials (RCTs) on adult patients after OHCA treated with epinephrine versus controls. Data extraction Independent, double-data extraction; risk of bias assessment with Cochrane Collaboration’s criteria. Data synthesis 15 RCTs representing 20 716 OHCA adult patients. Epinephrine, compared with all pooled treatments, was associated with a better survival rate to hospital discharge (RR: 1.16, 95% CI: 1.00–1.35) and a favorable neurologic outcome (RR: 1.24, 95% CI: 1.04–1.48). No difference was found in survival to hospital admission (RR: 1.02, 95% CI: 0.75–1.38) and ROSC when comparing epinephrine with all pooled treatments (RR: 1.13, 95% CI: 0.84–1.53). When epinephrine was compared with a placebo/no drugs, survival to hospital discharge (RR: 1.34, 95% CI: 1.08–1.67), ROSC (RR: 2.03, 95% CI: 1.18–3.51) and survival to hospital admission (RR: 2.04, 95% CI: 1.22–3.43) were increased, but there was not a favorable neurologic outcome (RR: 1.22, 95% CI: 0.99–1.51). Conclusions In OHCA, standard or high doses of epinephrine should be used because they improved survival to hospital discharge and resulted in a meaningful clinical outcome. There was also a clear advantage of using epinephrine over a placebo or no drugs in the considered outcomes.