The effectiveness of adrenaline in cardiopulmonary resuscitation: A systematic review

ABSTRACT

Introduction: Cardiac arrest is one of the leading causes of death. The incidence of in-hospital cardiac arrest is 1-5 per 1.000 patients with the survival to discharge reaching 15%-20%. Adrenaline is being used traditionally in cardiac arrest in an effort to systematic circulation maintenance and cerebral function.

Aim: The aim of this systematic review was to investigate the effectiveness of adrenaline in cardiopulmonary resuscitation, both for the rapid return of spontaneous circulation and for the optimal neurological outcome of patients with cardiac arrest.

Materials and Methods: We searched the relevant Greek and international bibliography from 2014 to 2019 in online international databases: Pubmed, ScienceDirect, Scopus, Cochrane, in Grey Literature, in journals of scientific interest and in postgraduate and doctoral programs in the departments of Medicine and Nursing. The key-words we used were: adrenaline, epinephrine, cardiac arrest, cardiopulmonary resuscitation.

Results: Out of the 497 articles found, 16 articles were finally selected to cover the topic under study. After the systematic review, the results showed that fewer doses of adrenaline, administered as quickly as possible, had better results in both rapid return of spontaneous circulation and survival with favorable neurological outcome, in patients with cardiac arrest. Multiple drugs and doses of adrenaline are associated with lower survival rates. There may be a need of individualized resuscitation, as patients with body weight >82.5kg seem to not receive adequate amounts of adrenaline.

Conclusions:  Fewer doses of adrenaline and other drugs that are used in cardiopulmonary resuscitation, administered as quickly as possible, have better effects on both rapid recovery of systematic circulation and favorable neurological outcome in patients with in-and out-of-hospital cardiac arrest.

Keywords: Adrenaline, epinephrine, cardiac arrest, cardiopulmonary resuscitation