Acta Pharmaceutica, Vol. 73 No. 3, 2023.
Review article
https://doi.org/10.2478/acph-2023-0022
Is epinephrine still the drug of choice during cardiac arrest in the emergency department of the hospital? A meta-analysis
MIN HOU
; Department of Cardiovascular Internal Medicine, People's Hospital of Dongxihu District Wuhan, Wuhan City, Hubei Province, 430040, China
SU DONG
; Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Wuhan City Hubei Province, 430040, China
QING KAN
; Department of Pharmacy, Hankou Hospital of Wuhan, Wuhan City, Hubei Province, 430040, China
MENG OUYANG
; Department of Pharmacy, The First People’s Hospital of Jiang Xia District, Wuhan City, Hubei Province, 430000, China
YUN ZHANG
; Department of Pharmacy, The First People’s Hospital of Jiang Xia District, Wuhan City, Hubei Province, 430000, China
Abstract
Epinephrine is the first-line emergency drug for cardiac arrest and anaphylactic reactions but is reported to be associated with many challenges resulting in its under- or improper utilization. Therefore, in this meta-analysis, the efficacy and safety of epinephrine as a first-line cardiac emergency drug for both out-of-hospital and in-hospital patients was assessed. Pertinent articles were searched in central databases like PubMed, Scopus, and Web of Science, using appropriate keywords as per the PRISMA guidelines. Retrospective and prospective studies were included according to the predefined PICOS criteria. RevMan and MedCalc software were used and statistical parameters such as odds ratio and risk ratio were calculated. Twelve clinical trials with a total of 208,690 cardiac arrest patients from 2000 to 2022 were included, in accordance with the chosen inclusion criteria. In the present meta-analysis, a high odds ratio (OR) value of 3.67 (95 % CI 2.32–5.81) with a tau2 value of 0.64, a chi2 value of 12,446.86, df value of 11, I2 value of 100 %, Z-value 5.53, and a p-value < 0.00001 were reported. Similarly, the risk ratio of 1.89 (95 % CI 1.47–2.43) with a tau2 value of 0.19, chi2 value of 11,530.67, df value of 11, I2 value of 100 %, Z-value of 4.95, and p-value < 0.000001. The present meta-analysis strongly prefers epinephrine injection as the first cardiac emergency drug for both out-of-hospital and in-hospital patients during cardiac arrest.
Keywords
cardiac arrest; epinephrine/adrenaline; cardiopulmonary resuscitation; cardiac-emergency medicine; intravenous injection; intracardiac injection
Hrčak ID:
301801
URI
Publication date:
30.9.2023.
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