Epinephrine May Be of No Survival Benefit in Cardiac Arrest

Kristi L. Koenig, MD, FACEP, FIFEM

A meta-analysis shows similar survival to discharge and neurological outcomes in adult cardiac arrest patients irrespective of epinephrine use or dose.

Standard advanced cardiac life support guidelines recommend administration of epinephrine at a dose of 1 mg every 3 to 5 minutes, but is there evidence that this therapy improves outcomes? To answer this question, researchers performed a meta-analysis of 14 randomized, controlled trials (12,250 total patients) in nine countries that compared standard-dose epinephrine with high-dose epinephrine (>1 mg per dose), vasopressin, or placebo in adults with out-of-hospital cardiac arrest.

Rates of survival to hospital admission and return of spontaneous circulation were higher with high-dose epinephrine than with the standard dose and were lower with placebo than with the standard dose. However, there were no differences in survival to discharge or neurological outcomes between any treatment groups or subgroups (initial cardiac rhythm, number of doses). The meta-analysis did not control for quality of cardiopulmonary resuscitation.

Citation(s):

Lin S et al. Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials. Resuscitation 2014 Mar 15; [e-pub ahead of print].