Cardiac arrest & resuscitation
Epinephrine in Out-of-Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms
Authors' conclusion
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.
Study context
- Population
- Patients with out-of-hospital cardiac arrest (OHCA) in RCTs evaluating epinephrine use during resuscitation (6 databases, inception through June 2022)
- Participants
- 21,594 patients · 18 trials
- Comparison
- Standard-dose epinephrine, high-dose epinephrine, epinephrine plus vasopressin vs placebo or no treatment
- Outcome
- Return of spontaneous circulation (ROSC)
Methodological detailsfrequentist random-effects network meta-analysis, GRADE certainty of evidence
- Frequentist random-effects network meta-analysis
- GRADE certainty of evidence
Pooled result
As reported in the abstract
Each group vs placebo or no treatmentOR for ROSC (95% CI)
High-dose epinephrine
4.27(3.68–4.97)
Standard-dose epinephrine
3.69(3.32–4.10)
Epinephrine plus vasopressin
3.54(2.94–4.26)
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| Survival to hospital admissionHigh-dose epinephrine vs Placebo or no treatment | OR for survival to hospital admission 3.53 (95% CI 2.97–4.20) | |
| Survival to hospital admissionStandard-dose epinephrine vs Placebo or no treatment | OR for survival to hospital admission 3.00 (95% CI 2.66–3.38) | |
| Survival to hospital admissionEpinephrine plus vasopressin vs Placebo or no treatment | OR for survival to hospital admission 2.79 (95% CI 2.27–3.44) | |
| Survival to discharge, nonshockable vs shockable rhythm (subgroup)Standard-dose epinephrine vs Placebo or no treatment · nonshockable rhythm | OR for survival to discharge (nonshockable rhythm) 2.10 (95% CI 1.21–3.63) | |
| Survival to discharge, nonshockable vs shockable rhythm (subgroup)Standard-dose epinephrine vs Placebo or no treatment · shockable rhythm | OR for survival to discharge (shockable rhythm) 0.85 (95% CI 0.39–1.85) | |
| 0.20.5125Ratio (log scale) |
Survival to discharge and survival with good functional outcome
- None of the agents may increase survival to discharge or survival with good functional outcome vs placebo or no treatment
Original publication
Epinephrine in Out-of-Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. Published 31 January 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →