Polish Society of Disaster Medicine, Warsaw, Poland.
Bialystok Oncology Center, Bialystok, Poland.
Cardiol J. 2021;28(2):279-292. doi: 10.5603/CJ.a2020.0133. Epub 2020 Nov 3.
There is a beneficial effect of adrenaline during adult cardiopulmonary resuscitation (CPR) from cardiac arrest but there is also uncertainty about its safety and effectiveness. The aim of this study was to evaluate the use of adrenaline versus non-adrenaline CPR.
PubMed, ScienceDirect, Embase, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases were searched from their inception up to 1st July 2020. Two reviewers independently assessed eligibility and risk of bias, with conflicts resolved by a third reviewer. Risk ratio (RR) or mean difference of groups were calculated using fixed or random-effect models.
Nineteen trials were identified. The use of adrenaline during CPR was associated with a significantly higher percentage of return of spontaneous circulation (ROSC) compared to non-adrenaline treatment (20.9% vs. 5.9%; RR = 1.87; 95% confidence interval [CI] 1.37-2.55; p < 0.001). The use of adrenaline in CPR was associated with ROSC at 19.4% and for non-adrenaline treatment - 4.3% (RR = 3.23; 95% CI 1.89-5.53; p < 0.001). Survival to discharge (or 30-day survival) when using adrenaline was 6.8% compared to non-adrenaline treatment (5.5%; RR = 0.99; 95% CI 0.76-1.30; p = 0.97). However, the use of adrenaline was associated with a worse neurological outcome (1.6% vs. 2.2%; RR = 0.57; 95% CI 0.42-0.78; p < 0.001).
This review suggests that resuscitation with adrenaline is associated with the ROSC and survival to hospital discharge, but no higher effectiveness was observed at discharge with favorable neurological outcome. The analysis showed higher effectiveness of ROSC and survival to hospital discharge in non-shockable rhythms. But more multicenter randomized controlled trials are needed in the future.
在成人心肺复苏（CPR）期间，肾上腺素有有益作用，但安全性和有效性仍存在不确定性。本研究旨在评估肾上腺素与非肾上腺素 CPR 的使用。
从建库至 2020 年 7 月 1 日，我们在 PubMed、ScienceDirect、Embase、CENTRAL（Cochrane 对照试验中心注册库）和 Google Scholar 数据库中进行了检索。两位审查员独立评估了纳入研究的资格和偏倚风险，如有分歧则由第三位审查员解决。使用固定或随机效应模型计算风险比（RR）或组间均值差。
共确定了 19 项试验。与非肾上腺素治疗相比，CPR 期间使用肾上腺素与更高的自主循环恢复（ROSC）百分比显著相关（20.9% vs. 5.9%；RR=1.87；95%置信区间[CI]1.37-2.55；p<0.001）。CPR 中使用肾上腺素的 ROSC 为 19.4%，而非肾上腺素治疗的 ROSC 为 4.3%（RR=3.23；95%CI1.89-5.53；p<0.001）。使用肾上腺素时的出院存活率（或 30 天存活率）为 6.8%，而非肾上腺素治疗为 5.5%（RR=0.99；95%CI0.76-1.30；p=0.97）。然而，肾上腺素的使用与较差的神经功能结局相关（1.6% vs. 2.2%；RR=0.57；95%CI0.42-0.78；p<0.001）。
本综述表明，肾上腺素复苏与 ROSC 和存活至出院相关，但出院时神经功能结局良好的效果无提高。分析显示在非可电击节律中 ROSC 和存活至出院的效果更高。但未来仍需要更多多中心随机对照试验。
