title: Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis.
abstract: BACKGROUND
  The aim of this study was to conduct a systematic review and meta-analysis for determining the effects of prehospital adrenaline administration on return of spontaneous circulation, hospital admission, survival to discharge and discharge with cerebral performance category 1 or 2 in out-of-hospital cardiac arrest patients.
  
  
  METHODS
  MEDLINE and Scopus databases were searched to identify studies reported to March 2014. Study selection and data extraction were independently completed by two reviewers (PA and SR). The baseline characteristics of each study and number of events were extracted. Risk ratios (RR) and 95% confidence interval (CI) were estimated. Heterogeneity and publication bias were also explored.
  
  
  RESULTS
  In total 15 studies were eligible and included in the study. Of 13 adult observational studies, four to eight studies were pooled for each outcome. These yielded a total sample size that ranged from 2,381 to 421,459. A random effects model suggested that patients receiving prehospital adrenaline were 2.89 times (95% CI: 2.36, 3.54) more likely to achieve prehospital return of spontaneous circulation than those not administered adrenaline. However, there were no significant effects on overall return of spontaneous circulation (RR = 0.93, 95% CI: 0.5, 1.74), admission (RR = 1.05, 95% CI: 0.80, 1.38) and survival to discharge (RR = 0.69, 95% CI: 0.48, 1.00).
  
  
  CONCLUSIONS
  Prehospital adrenaline administration may increase prehospital return of spontaneous circulation, but it does not improve overall rates of return of spontaneous circulation, hospital admission and survival to discharge.
authors: Pongsakorn
authors: P
authors: Atiksawedparit
authors: Sasivimol
authors: S
authors: Rattanasiri
authors: Mark
authors: M
authors: McEvoy
authors: Colin A
authors: CA
authors: Graham
authors: Yuwares
authors: Y
authors: Sittichanbuncha
authors: Ammarin
authors: A
authors: Thakkinstian
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D016206:Databases, Bibliographic; D004632:Emergency Medical Services / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D010351:Patient Discharge; D012075:Remission, Spontaneous; D016019:Survival Analysis; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine