Epinephrine in cardiac arrest: systematic review and meta-analysis.
Ignacio Morales-Cané, María Del Rocío Valverde-León, María Aurora Rodríguez-Borrego
PMID 27982306WHAT IT FOUND
Epinephrine in cardiac arrest increased return of spontaneous circulation and survival to discharge compared with no epinephrine, but not favorable neurologic outcome.
Early doses and 1-5 minute intervals were associated with better survival; high or widely spaced doses with worse.
Key findings
01Compared with no epinephrine or placebo, epinephrine increased survival to hospital discharge or 30 days, but did not significantly improve survival with favorable neurologic status.
02Epinephrine increased return of spontaneous circulation compared with no epinephrine, with a significant stratified increase in pulseless electrical activity or asystole and no significant difference in ventricular fibrillation or ventricular tachycardia.
03High epinephrine doses above 5.5 mg were associated with higher hospital mortality and unfavorable neurologic status, and doses more than 5 minutes apart were associated with lower survival.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies were observational, so uncontrolled differences could have affected the results. Heterogeneity was high for several key outcomes, including survival to discharge or 30 days and return of spontaneous circulation. Some outcomes depended on one study, including 1-year survival and 1-year survival with favorable neurologic status. The review did not find enough data for all desired outcomes to reach statistically significant results. Emergency team organization and training varied across countries, which could bias comparisons.
The easy way to misread this
Do not conclude that epinephrine improves neurologic recovery or long-term survival. The review found no significant difference in survival with favorable neurologic status, and one observational analysis reported lower one-year survival with epinephrine.