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Lesson 6 of10
In Progress

Literature Review for Epinephrine

Jimmy September 14, 2021

Primary Outcomes That Matter!


Summary of Epinephrine Dose Data

AuthorDesignDoseOutcome
Brown, 1992RCT n =1280EPI  0.02 mg/kg (SDA) EPI 0.2 mg/kg (HDA)No difference in ROSC, Hospital admission, discharge from hospital
Choux, 1995RCT n = 536EPI  1 mg (SDA) EPI 5 mg (HDA)No difference in ROSC, Hospital admission, discharge from hospital, neurological function
Fisk, 2018Observational n=2255EPI 1 mg EPI 0.5 mgNo difference in ROSC, discharge from hospital, neurological function
Gueugniaud, 1998RCT n = 3327EPI  1 mg (SDA) EPI 5 mg (HDA)EPI 5 mg ↑ ROSC, hospital discharge compared to EPI 1 mg No Difference in hospital discharge and neurological function
Stiell, 1992RCT n = 335EPI  1 mg (SDA) EPI 7 mg (HDA)No difference in 1 hr survival, hospital discharge, or neurological function

Summary of Epinephrine Efficacy and Safety Data

AuthorYearDesignOutcome (EPI vs Comparator)
Holmberg et al.2002Observational↑ Mortality 
Stiell et al. (OPALS)2004Observational↑ ROSC ↔neurological intact survival
Ong et al.2007Observational↔ neurological intact survival
Olasveengen et al.2009RCT↑ ROSC ↔/↑* neurological intact survival
Jacobs et al.2011RCT↑ ROSC ↔ neurological intact survival
Hagihara et al.2012Observational↑ ROSC ↓ neurological intact survival
Nakahara et al.2013Observational↔ neurological intact survival or Mortality
Dumas et al.2014Observational↓ Neuro intact survival
Sanghavi et al.2015Observational↑ Mortality  ↓ Neuro intact survival
Perkins, 2018 (PARAMEDIC-2)2018RCT↓ Mortality ↑ ROSC ↔ neurological intact survival
* Post Hoc analysis

Objective

  • In adult patients that present to paramedics with out-of-hospital arrest in the field, does acute cardiac life support performed with epinephrine as compared to placebo lead to improved survival and neurological outcome.

Methods


Intervention



PARAMEDIC 2 Results



Neurologic Impairment


Author’s Conclusion


Strengths & Limitations