Huan Lu, Qin Fei, Wu Yin
Department of Hepatobiliary Surgery, Chongqing Fifth People's Hospital.
Department of Assisted Reproduction, The First Affiliated Hospital of Chongqing Medical University.
Medicine (Baltimore). 2019 Nov;98(45):e17502. doi: 10.1097/MD.0000000000017502.
Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest.
Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes.
Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test.
In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001).
In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.
我们的目标是评估肾上腺素对院外心脏骤停的影响。
心脏骤停是最严重的医疗事件，在美国估计发病率为每10万人年95.7例。尽管肾上腺素可改善冠状动脉和脑灌注，提高自主循环恢复率，但对心脏的潜在有害影响会导致心肌氧需求增加。关于肾上腺素对院外心脏骤停影响的担忧存在争议，需要更高层次的论证来确定肾上腺素对短期和长期结果是否安全有效。
检索包括各种检索工具的数据库，如Medline、Cochrane图书馆、Embase、PubMed等。所有纳入研究应符合我们本次荟萃分析的要求。在以下所有感兴趣的结果中，我们充分利用STATA进行评估，主要测量指标是风险比（RR）及95%置信区间，采用Egger检验评估发表偏倚。
在本次关于肾上腺素用于院外心脏骤停的随机试验的系统评价和荟萃分析中，我们发现与未使用肾上腺素相比，使用肾上腺素使自主循环恢复（ROSC）的可能性显著更高（RR = 3.05，I² = 23.1%，P = 0.0001）以及出院生存率更高（RR = 1.40，I² = 36.3%，P = 0.008）。相反，肾上腺素并未增加脑功能分级1或2级（CPC 1或2）（RR = 1.15，I² = 40.5%，P = 0.340）以及住院率（RR = 2.07，I² = 88.2%，P = 0.0001）。
总之，在本次涉及多项研究的系统评价和荟萃分析中，与未使用肾上腺素相比，使用肾上腺素使出院生存率和自主循环恢复的可能性显著更高，但两组在良好神经功能结局发生率方面无显著差异。
