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In this systematic review and meta-analysis, researchers found that epinephrine in standard doses, high doses, and with vasopressin lead to an improvement in ROSC and survival to hospital admission in out-of-hospital cardiac arrest (OHCA) but did not improve survival to discharge or functional neurologic outcome.
Why does this matter?
Epinephrine is part of American Heart Association guidelines for the treatment of cardiac arrest, but the PARAMEDIC-2 trial showed that epinephrine improved ROSC but not long term functional outcome. Use of epinephrine has been a point of controversy for over 100 years. We covered an epinephrine meta-analysis back in 2019, which showed improved ROSC and survival – though not with favorable neurological outcome.
Overall, this study supports the current recommendation for 1mg epinephrine dosing in non-shockable OHCA. For shockable rhythms, shock first before trying 1mg epinephrine. This study does not find any role for vasopressin in the treatment of OHCA.
Source
Epinephrine in Out-of-Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023 Jan 31:S0012-3692(23)00165-4. doi: 10.1016/j.chest.2023.01.033. Epub ahead of print.
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