Epinephrine in Out-of-Hospital Cardiac Arrest A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms

被引：18

作者：

Fernando, Shannon M. ^{[1
,2
,5
,6
]}

Mathew, Rebecca ^{[5
]}

Sadeghirad, Behnam ^{[3
,5
,7
,8
]}

Rochwerg, Bram ^{[8
,9
]}

Hibbert, Benjamin

Munshi, Laveena ^{[10
,12
,13
]}

Fan, Eddy ^{[10
,12
,13
,14
,15
]}

Brodie, Daniel ^{[18
,19
,20
,21
]}

Di Santo, Pietro ^{[1
,4
,5
]}

Tran, Alexandre ^{[1
,4
]}

Mcleod, Shelley L. ^{[8
,11
,17
]}

Vaillancourt, Christian ^{[2
,4
,6
]}

Cheskes, Sheldon ^{[11
,17
,18
]}

Ferguson, Niall D. ^{[10
,13
,14
,15
,16
]}

Scales, Damon C. ^{[10
,13
,14
,15
,18
,19
]}

Lin, Steve ^{[11
,13
,18
]}

Sandroni, Claudio ^{[22
,23
]}

Soar, Jasmeet ^{[24
]}

Dorian, Paul ^{[12
,18
]}

Perkins, Gavin D. ^{[25
]}

Nolan, Jerry P. ^{[25
,26
]}

机构：

[1] Univ Ottawa, Dept Med, Div Crit Care, Ottawa, ON, Canada

[2] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada

[3] Univ Ottawa, Dept Cellular & Mol Med, Ottawa, ON, Canada

[4] Univ Ottawa, Sch Publ Hlth & Epidemiol, Ottawa, ON, Canada

[5] Univ Ottawa, Heart Inst, Div Cardiol, CAPITAL Res Grp, Ottawa, ON, Canada

[6] Ottawa Hosp Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada

[7] McMaster Univ, Dept Anesthesia, Hamilton, ON, Canada

[8] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[9] McMaster Univ, Dept Med, Div Crit Care, Hamilton, ON, Canada

[10] Univ Toronto, Interdept Div Crit Care Med, Dept Med, Toronto, ON, Canada

[11] Univ Toronto, Dept Med, Div Emergency Med, Toronto, ON, Canada

[12] Univ Toronto, Dept Med, Div Cardiol, Toronto, ON, Canada

[13] Univ Toronto, Dalla Lana Sch Publ Hlth, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[14] Sinai Hlth Syst, Dept Med, Toronto, ON, Canada

[15] Univ Hlth Network, Toronto, ON, Canada

[16] Univ Hlth Network, Toronto Gen Hosp, Res Inst, Toronto, ON, Canada

[17] Sinai Hlth, Schwartz Reisman Emergency Med Inst, Toronto, ON, Canada

[18] St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada

[19] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada

[20] Columbia Univ, Dept Med, Coll Phys & Surg, Div Pulm Allergy & Crit Care Med, New York, NY USA

[21] New York Presbyterian Hosp, Ctr Acute Resp Failure, New York, NY USA

[22] Univ Cattolica Sacro Cuore, Inst Anesthesiol & Intens Care Med, Rome, Italy

[23] Fdn Policlin Univ Agostino Gemelli IRCCS, Dept Anesthesiol Intens Care & Emergency Med, Rome, Italy

[24] North Bristol NHS Trust, Southmead Hosp, Bristol, England

[25] Univ Warwick, Warwick Med Sch, Warwick Clin Trials Unit, Gibbet Hill, Coventry, England

[26] Royal United Hosp Bath, Dept Anaesthesia & Intens Care Med, Bath, England

来源：

CHEST | 2023年 / 164卷 / 02期

关键词：

KEY WORDS; critical care medicine; emergency medicine; epinephrine; out-of-hospital cardiac arrest; return of spontaneous circulation; HIGH-DOSE EPINEPHRINE; INTERNATIONAL LIAISON COMMITTEE; AMERICAN-HEART-ASSOCIATION; CARDIOPULMONARY-RESUSCITATION; ADRENALINE EPINEPHRINE; EUROPEAN RESUSCITATION; DOUBLE-BLIND; VASOPRESSIN; INCONSISTENCY; SURVIVAL;

D O I：

10.1016/j.chest.2023.01.033

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: Epinephrine is the most commonly used drug in out-of-hospital cardiac arrest (OHCA) resuscitation, but evidence supporting its efficacy is mixed. RESEARCH QUESTION: What are the comparative efficacy and safety of standard dose epinephrine, high-dose epinephrine, epinephrine plus vasopressin, and placebo or no treatment in improving outcomes after OHCA? STUDY DESIGN AND METHODS: In this systematic review and network meta-analysis of randomized controlled trials, we searched six databases from inception through June 2022 for randomized controlled trials evaluating epinephrine use during OHCA resuscitation. We performed frequentist random-effects network meta-analysis and present ORs and 95% CIs. We used the the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate the certainty of evidence. Outcomes included return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge, and survival with good functional outcome. RESULTS: We included 18 trials (21,594 patients). Compared with placebo or no treatment, high-dose epinephrine (OR, 4.27; 95% CI, 3.68-4.97), standard-dose epinephrine (OR, 3.69; 95% CI, 3.32-4.10), and epinephrine plus vasopressin (OR, 3.54; 95% CI, 2.94-4.26) all increased ROSC. High-dose epinephrine (OR, 3.53; 95% CI, 2.97-4.20), standard-dose epinephrine (OR, 3.00; 95% CI, 2.66-3.38), and epinephrine plus vasopressin (OR, 2.79; 95% CI, 2.27-3.44) all increased survival to hospital admission as compared with placebo or no treatment. However, none of these agents may increase survival to discharge or survival with good functional outcome as compared with placebo or no treatment. Compared with placebo or no treatment, standard-dose epinephrine improved survival to discharge among patients with nonshockable rhythm (OR, 2.10; 95% CI, 1.21-3.63), but not in those with shockable rhythm (OR, 0.85; 95% CI, 0.39-1.85). INTERPRETATION: Use of standard-dose epinephrine, high-dose epinephrine, and epinephrine plus vasopressin increases ROSC and survival to hospital admission, but may not improve survival to discharge or functional outcome. Standard-dose epinephrine improved survival to discharge among patients with nonshockable rhythm, but not those with shockable rhythm. TRIAL REGISTRY: Center for Open Science: https://osf.io/arxwq

引用

页码：381 / 393

页数：13

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