Prehospital adrenaline use for out-of-hospital cardiac arrest

What is it about?

Adrenaline has been recommended for out-of-hospital cardiac arrest (OHCA) resuscitation for nearly a century, but its efficacy and safety remain unclear in the literature. The primary aim of this review was to determine whether adrenaline increase the return of spontaneous circulation in OHCA patients. We sought randomised clinical trials in MEDLINE, EMBASE and CENTRAL from their inception until October 2018. Observational studies, case reports, case series and non-systematic reviews were excluded. Two trials including 8,548 patients were eligible for inclusion in the data synthesis. In patients who received adrenaline during OHCA, the incidence of return of spontaneous circulation was increased, with an odds ratio (95%Cl) of 4.25 (3.79-4.75), ρ<0.001, high quality of evidence. The number of patients transported to hospital was increased in patients who had prehospital adrenaline, with an odds ratio (95%Cl) of 2.31 (2.11-2.53), ρ<0.001, high quality of evidence. The prehospital use of adrenaline was associated with an increased survival to hospital discharge, the odds ratio (95%Cl) being 1.43 (1.10-1.87), ρ=0.008, moderate quality of evidence. No significant effect was noted on the favourable neurologic state of patient at hospital discharge, with an odds ratio (95%Cl) of 1.16 (0.85-1.58), ρ=0.35, moderate quality of evidence. The trial sequential analysis for both return of spontaneous circulation and patients transported to hospital was conclusive but not for the survival to hospital discharge and favourable neurologic outcomes at hospital discharge. In summary, this meta-analysis suggests that the prehospital use of adrenaline increases return of spontaneous circulation, transport of patients to hospital and survival to hospital discharge for OHCA. The general quality of evidence ranged from moderate to high. PROSPERO Registration: CRD42018111763

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Why is it important?

This meta-analysis suggests that the prehospital use of adrenaline increases return of spontaneous circulation, transport of patients to hospital and survival to hospital discharge for OHCA. The general quality of evidence ranged from moderate to high.

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