• Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis

    by Alan Batt. Last modified: 04/08/14

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    Atiksawedparit P, Rattanasiri S, McEvoy M, Graham CA, Sittichanbuncha Y, Thakkinstian A. Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis. Crit Care. 2014 Jul 31;18(4):463. PMID: 25079607.

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    Abstract

    Introduction

    The aim of this study was to conduct a systematic review and meta-analysis for determining the effects of prehospital adrenaline administration on return of spontaneous circulation, hospital admission, survival to discharge and discharge with cerebral performance category 1 or 2 in out-of-hospital cardiac arrest patients.

    Methods

    MEDLINE and Scopus databases were searched to identify studies reported to March 2014. Study selection and data extraction were independently completed by two reviewers (PA and SR). The baseline characteristics of each study and number of events were extracted. Risk ratios were pooled. Heterogeneity and publication bias were also explored.

    Results

    In total 15 studies were eligible and included in the study. Of 13 adult observational studies, 4 to 8 studies were pooled for each outcome. These yielded a total sample size that ranged from 2381 to 421,459. A random effects model suggested that patients receiving prehospital adrenaline were 2.89 times (95% CI: 2.36, 3.54) more likely to achieve prehospital return of spontaneous circulation than those not administered adrenaline. However, there were no significant effects on overall return of spontaneous circulation (RR¿=¿0.93, 95% CI: 0.5, 1.74), admission (RR¿=¿1.05, 95% CI: 0.80, 1.38) and survival to discharge (RR¿=¿0.69, 95% CI: 0.48, 1.00).

    Conclusions

    Prehospital adrenaline administration may increase prehospital return of spontaneous circulation, but it does not improve overall rates of return of spontaneous circulation, hospital admission and survival to discharge.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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