Is epinephrine still the drug of choice during cardiac arrest in the emergency department of the hospital? A meta-analysis

1M. Hayashi, W. Shimizu and C. M. Albert, the spectrum of epidemiology underlying sudden cardiac death, Circ. Res. 116(12) (2015) 1887–1906; https://doi.org/10.1161/CIRCRESAHA.116.304521Search in Google Scholar

2D. G. Katritsis, B. J. Gersh and A. J. Camm, A clinical perspective on sudden cardiac death, Arrhythm. Electrophysiol. Rev. 5(3) (2016) 177–182; https://doi.org/10.15420/aer.2016:11:2Search in Google Scholar

3K. D. Patil, H. R. Halperin and L. B. Becker, Cardiac arrest: resuscitation and reperfusion, Circ. Res. 116(12) (2015) 2041–2049; https://doi.org/10.1161/CIRCRESAHA.116.304495Search in Google Scholar

4D. E. Becker, Emergency drug kits: pharmacological and technical considerations, Anesth. Prog. 61(4) (2014) 171–179; https://doi.org/10.2344/0003-3006-61.4.171Search in Google Scholar

5T. Boyd and W. Brady, The “Code Drugs in Cardiac Arrest” – the use of cardioactive medications in cardiac arrest resuscitation, Am. J. Emerg. Med. 30(5) (2012) 811–818; https://doi.org/10.1016/j.ajem.2011.04.009Search in Google Scholar

6J. H. Fugate, Pharmacologic management of cardiac emergencies, J. Infus. Nurs. 29(3) (2006) 147–150; https://doi.org/10.1097/00129804-200605000-00004Search in Google Scholar

7R. Davison, V. Barresi, M. Parker, S. N. Meyers and J. V. Talano, Intracardiac injections during cardiopulmonary resuscitation. A low-risk procedure, JAMA 244(10) (1980) 1110–1111.Search in Google Scholar

8A. Granfeldt, S. R. Avis, P. C. Lind, M. J. Holmberg, M. Kleinman, I. Maconochie, C. H. Hsu, M. Fernanda de Almeida, T. L. Wang, R. W. Neumar and L. W. Andersen, Intravenous vs. intraosseous administration of drugs during cardiac arrest: A systematic review, Resuscitation 149 (2020) 150–157; https://doi.org/10.1016/j.resuscitation.2020.02.025Search in Google Scholar

9J. J. Polania Gutierrez and S. Munakomi, Intramuscular Injection, StatPearls Publishing, Treasure Island (FL) 2022Search in Google Scholar

10P. J. Carr, L. O’Connor, G. Gethin, J. D. Ivory, P. O’Hara, O. O’Toole and P. Healy, In the preparation and administration of intravenous medicines, what are the best practice standards that healthcare professionals need to follow to ensure patient safety? Protocol for a systematic review, HRB Open Res. 3 (2021) Article ID 19 (8 pages); https://doi.org/10.12688/hrbopenres.13028.3 (last updated March 23, 2022)Search in Google Scholar

11Y. Hayash, T. Iwami, T. Kitamura, T. Nishiuchi, K. Kajino, T. Sakai, C. Nishiyama, M. Nitta, A. Hiraide and T. Kai, Impact of early intravenous epinephrine administration on outcomes following out-of-hospital cardiac arrest, Circ. J. 76(7) (2012) 1639–1645; https://doi.org/10.1253/circj.cj-11-1433Search in Google Scholar

12I. G. Stiell, P. C. Hébert, G. A. Wells, K. L. Vandemheen, A. S. L. Tang, L. A. J. Higginson, J. F. Dreyer, C. Clement, E. Battram, I. Watpool, S. Mason, T. Klassen and B. N. Weitzman, Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial, Lancet 358(9276) (2001) 105–109; https://doi.org/10.1016/S0140-6736(01)05328-4Search in Google Scholar

13V. Wenzel, A. C. Krismer, H. R. Arntz, H. Sitter, K. H. Stadlbauer and K. H. Lindner (for European resuscitation council vasopressor during cardiopulmonary resuscitation study group), A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation, N. Engl. J. Med. 350(2) (2004) 105–113; https://doi.org/10.1056/NEJMoa025431Search in Google Scholar

14S. D. Mentzelopoulos, S. G. Zakynthinos, M. Tzoufi, N. Katsios, A. Papastylianou, S. Gkisioti, A. Stathopoulos, A. Kollintza, E. Stamataki and C. Roussos, Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest, Arch. Intern. Med. 169(1) (2009) 15–24; https://doi.org/10.1001/archinternmed.2008.509Search in Google Scholar

15I. G. Jacobs, J. C. Finn, G. A. Jelinek, H. F. Oxer and P. L. Thompson, Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial, Resuscitation 82(9) (2011) 1138–1143; https://doi.org/10.1016/j.resuscitation.2011.06.029Search in Google Scholar

16M. E. Ong, L. Tiah, B. S. Leong, E. C. Tan, V. Y. Ong, E. A. Tan, B. Y. Poh, P. P. Pek and Y. Chen, A randomised, double-blind, multi-centre trial comparing vasopressin and adrenaline in patients with cardiac arrest presenting to or in the emergency department, Resuscitation 83(8) (2012) 953–960; https://doi.org/10.1016/j.resuscitation.2012.02.005Search in Google Scholar

17C. Koscik, A. Pinawin, H. McGovern, D. Allen, D. E. Media, T. Ferguson, W. Hopkins, K. N. Sawyer, J. Boura and R. Swor, Rapid epinephrine administration improves early outcomes in out-of-hospital cardiac arrest, Resuscitation 84(7) (2013) 915–920; https://doi.org/10.1016/j.resuscitation.2013.03.023Search in Google Scholar

18M. W. Donnino, J. D. Salciccioli, M. D. Howell, M. N. Cocchi, B. Giberson, K. Berg, S. Gautam and C. Callaway (for American heart association), Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry, BMJ 348 (2014) Article ID g3028 (9 pages); https://doi.org/10.1136/bmj.g3028Search in Google Scholar

19H. Tanaka, H. Takyu, R. Sagisaka, H. Ueta, T. Shirakawa, T. Kinoshi, H. Takahashi, T. Nakagawa, S. Shimazaki and M. Ong Eng Hock, Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients, Am. J. Emerg. Med. 34(12) (2016) 2284–2290; https://doi.org/10.1016/j.ajem.2016.08.026Search in Google Scholar

20L. A. Hajjar, J. L. Vincent, F. R. Barbosa Gomes Galas, A. Rhodes, G. Landoni, E. A. Osawa, R. R. Melo, M. R. Sundin, S. M. Grande, F. A. Gaiotto, P. M. Pomerantzeff, L. O. Dallan, R. A. Franco, R. E. Nakamura, L. A. Lisboa, J. P. de Almeida, A. M. Gerent, D. H. Souza, M. A. Gaiane, J. T. Fukushima, C. L. Park, C. Zambolim, G. S. Rocha Ferreira, T. M. Strabelli, F. L. Fernandes, L. Camara, S. Zeferino, V. G. Santos, M. A. Piccioni, F. B. Jatene, J. O. Costa Auler Jr. and R. K. Filho, Vasopressin versus norepinephrine in patients with vasoplegic shock after cardiac surgery: The VANCS randomized controlled trial, Anesthesiology 126(1) (2017) 85–93; https://doi.org/10.1097/ALN.0000000000001434Search in Google Scholar

21G. D. Perkins, C. Ji, C. D. Deakin, T. Quinn, J. P. Nolan, C. Scomparin, S. Regan, J. Long, A. Slowther, H. Pocock, J. J. M. Black, F. Moore, R. T. Fothergill, N. Rees, L. O’Shea, M. Docherty, I. Gunson, K. Han, K. Charlton, J. Finn, S. Petrou, N. Stallard, S. Gates and R. Lall (for PARAMEDIC2 collaborators), A randomized trial of epinephrine in out-of-hospital cardiac arrest, N. Engl. J. Med. 379(8) (2018) 711–721; https://doi.org/10.1056/NEJMoa1806842Search in Google Scholar

22Y. Zhang, J. Zhu, Z. Liu, L. Gu, W. Zhang, H. Zhan, C. Hu, J. Liao, Y. Xiong and A. H. Idris, Intravenous versus intraosseous adrenaline administration in out-of-hospital cardiac arrest: A retrospective cohort study, Resuscitation 149 (2020) 209–216; https://doi.org/10.1016/j.resuscitation.2020.01.009Search in Google Scholar

23M. Okubo, S. Komukai, C. W. Callaway and J. Izawa, Association of timing of epinephrine administration with outcomes in adults with out-of-hospital cardiac arrest, JAMA Network Open 4(8) (2021) e2120176 (14 pages); https://doi.org/10.1001/jamanetworkopen.2021.20176Search in Google Scholar

24L. Huan, L. F. Qin and Y. Wu, Effects of epinephrine for out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials, Medicine (Baltimore) 98(45) (2019) Article ID e17502 (9 pages); https://doi.org/10.1097/MD.0000000000017502Search in Google Scholar

25P. C. Wyer, P. Perera, Z. Jin, Q. Zhou, D. J. Cook, S. D. Walter and G. H. Guyatt, Vasopressin or epinephrine for out-of-hospital cardiac arrest, Ann. Emerg. Med. 48(1) (2006) 86–97; https://doi.org/10.1016/j.annemergmed.2005.11.024Search in Google Scholar

26K. Ludwin, K. Safiejko, J. Smereka, K. Nadolny, M. Cyran, R. Yakubtsevich, M. J. Jaguszewski, K. J. Filipiak, L. Szarpak and A. Rodríguez-Núñez, Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation, Cardiol. J. 28(2) (2021) 279–292; https://doi.org/10.5603/CJ.a2020.0133Search in Google Scholar

27K. Srisurapanont, T. Thepchinda, S. Kwangsukstith, S. Saetiao, C. Kasirawat, W. Janmayka and W. Wongtanasarasin, Comparing drugs for out-of-hospital, shock-refractory cardiac arrest: Systematic review and network meta-analysis of randomized controlled trials, West J. Emerg. Med. 22(4) (2021) 834–841; https://doi.org/10.5811/westjem.2021.2.49590Search in Google Scholar

28I. Morales-Cané, M. Del Rocio Valverde-León and M. A. Rodríguez-Borrego, Epinephrine in cardiac arrest: systematic review and meta-analysis, Rev. Latino-Am. Enfermagem 24 (2016) Article ID e2821 (12 pages); https://doi.org/10.1590/1518-8345.1317.2821Search in Google Scholar

29A. Lundin, T. Djärv, J. Engdahl, J. Hollenberg, P. Nordberg, A. Ravn-Fischer, M. Ringh, S. Rysz, L. Svensson, J. Herlitz and P. Lundgren, Drug therapy in cardiac arrest: a review of the literature, Eur. Heart J. Cardiovasc. Pharmacother. 2(1) (2016) 54–75; https://doi.org/10.1093/ehjcvp/pvv047Search in Google Scholar

30D. Gallimore, Understanding the drugs used during cardiac arrest response, Nurs. Times 102(23) (2006) 24-26.Search in Google Scholar

31A. Papastylianou and S. Mentzelopoulos, Current pharmacological advances in the treatment of cardiac arrest, Emerg. Med. Int. 2011 (2012) Article ID 815857 (26 pages); https://doi.org/10.1155/2012/815857Search in Google Scholar

32S. S. Sinha, D. Sukul, J. J. Lazarus, V. Polavarapu, P. S. Chan, R. W. Neumar and B. K. Nallamothu, Identifying important gaps in randomized controlled trials of adult cardiac arrest treatments: A systematic review of the published literature, Circ. Cardiovasc. Qual. Outcomes 9(6) (2016) 749–756; https://doi.org/10.1161/CIRCOUTCOMES.116.002916Search in Google Scholar

33S. A. Amacher, C. Bohren, R. Blatter, C. Becker, K. Beck, J. Mueller, N. Loretz, S. Gross, K. Tisljar, R. Sutter, C. Appenzeller-Herzog, S. Marsch and S. Hunziker, Long-term survival after out-of-hospital cardiac arrest: A systematic review and meta-analysis, JAMA Cardiol. 7(6) (2022) 633–643; https://doi.org/10.1001/jamacardio.2022.0795Search in Google Scholar

34J. Jung, J. Rice and S. Bord, Rethinking the role of epinephrine in cardiac arrest: the PARAMEDIC2 trial, Ann. Transl. Med. 6(Suppl. 2) (2018) Article ID S129 (3 pages); https://doi.org/10.21037/atm.2018.12.31Search in Google Scholar

35C. J. R. Gough and J. P. Nolan, The role of adrenaline in cardiopulmonary resuscitation, Crit. Care 22(1) (2018) Article ID 139 (8 pages); https://doi.org/10.1186/s13054-018-2058-1Search in Google Scholar

36L. Schmidt, F. Shokraneh, K. Steinhausen and C. E. Adams, Introducing RAPTOR: RevMan parsing tool for reviewers, Syst. Rev. 8(1) (2019) Article ID 151 (4 pages); https://doi.org/10.1186/s13643-019-1070-0Search in Google Scholar

37S. J. Kuritz, J. R. Landis and G. G. Koch, A general overview of Mantel-Haenszel methods: applications and recent developments, Annu. Rev. Pub. Health 9 (1988) 123–160; https://doi.org/10.1146/annurev.pu.09.050188.001011Search in Google Scholar

38The Nordic Cochrane Centre, The Cochrane Collaboration, Review Manager, RevMan, Version 5, Copenhagen 2020Search in Google Scholar

39L. Lin and H. Chu, Quantifying publication bias in meta-analysis, Biometrics 74(3) (2018) 785–794; https://doi.org/10.1111/biom.12817Search in Google Scholar

40A. Elovic and A. Pourmand, MDCalc medical calculator app review, J. Digit. Imaging 32(5) (2019) 682–684; https://doi.org/10.1007/s10278-019-00218-ySearch in Google Scholar

41D. F. Williamson, R. A. Parker and J. S. Kendrick, The box plot: a simple visual method to interpret data, Ann. Intern. Med. 110(11) (1989) 916–921; https://doi.org/10.7326/0003-4819-110-11-916Search in Google Scholar

42W. A. van Enst, E. Ochodo, R. J. P. M. Scholten, L. Hooft and M. M. Leeflang, Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological study, BMC Med. Res. Methodol. 14 (2014) Article ID 70 (11 pages); https://doi.org/10.1186/1471-2288-14-70Search in Google Scholar

43S. H. Sicherer, F. E. R. Simons, T. A. Mahr, S. L. Abramson, C. Dinakar, T. A. Fleisher, A.-M. Irani, J. S. Kim and E. C. Matsui, Epinephrine for first-aid management of anaphylaxis, Pediatrics 139(3) (2017) e20164006 (9 pages); https://doi.org/10.1542/peds.2016-4006Search in Google Scholar

44J. M. Perlman, J. Wyllie, J. Kattwinkel, M. H. Wyckoff, K. Aziz, R. Guinsburg, H.-S. Kim, H. G. Liley, L. Mildenhall, W. M. Simon, E. Szyld, M. Tamura and S. Velaphi (on behalf of Neonatal resuscitation chapter collaborators), Part 7: Neonatal resuscitation: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations, Circulation 132(16 – Suppl. 1) S204–S241; https://doi.org/10.1161/CIR.0000000000000276Search in Google Scholar

45T.-C. Chu, R. P. Ojha and T. J. VanderWeele, Empirical comparison of approaches for odds ratios to risk ratio transformations in meta-analyses of randomized controlled trials with common outcomes, Ann. Epidemiol. 44 (2020) 57–59.e3; https://doi.org/10.1016/j.annepidem.2020.03.005Search in Google Scholar

46W. G. Melsen, M. C. Bootsma, M. M. Rovers and M. J. Bonten, The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses, Clin. Microbiol. Infect. 20(2) (2014) 123–129; https://doi.org/10.1111/1469-0691.12494Search in Google Scholar

47K. Thorlund, G. Imberger, B. C. Johnston, M. Walsh, T. Awad, L. Thabane, C. Gluud, P. J. Devereaux and J. Wetterslev, Evolution of heterogeneity (I2) estimates and their 95% confidence intervals in large meta-analyses, PLoS One 7(7) (2012) e39471 (8 pages); https://doi.org/10.1371/journal.pone.0039471Search in Google Scholar

48D. V. Zaykin, Optimally weighted Z-test is a powerful method for combining probabilities in meta-analysis, J. Evol. Biol. 24(8) (2011) 1836–1841; https://doi.org/10.1111/j.1420-9101.2011.02297.xSearch in Google Scholar