Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis
Effects of prehospital adrenaline administration on out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis
复制标题
DOI：
10.1186/s13054-014-0463-7
复制
发表时间：
2014-01-01
期刊：
影响因子：
15.1
通讯作者：
Thakkinstian, Ammarin
中科院分区：
文献类型：
--
作者：
Atiksawedparit, Pongsakorn;Rattanasiri, Sasivimol;Thakkinstian, Ammarin
导言：本研究的目的是进行系统回顾和荟萃分析，以确定院前应用肾上腺素对院外心脏骤停患者自主循环恢复、住院、出院存活率和脑功能1级或2级的影响。方法：检索Medline和Scope数据库，以确定截至2014年3月的研究报告。研究选择和数据提取由两位评审员(PA和SR)独立完成。提取了每项研究的基线特征和事件数量。估计危险比(RR)和95%可信区间(CI)。结果：共有15篇研究符合条件，纳入本研究。在13项成人观察性研究中，每个结果都汇集了四到八项研究。这些方法得出的总样本量从2381到421,459不等。随机效应模型显示，院前接受肾上腺素治疗的患者达到院前自主循环恢复的可能性是未使用肾上腺素的患者的2.89倍(95%CI：2.36，3.54)。但对自主循环恢复(RR=0.93，95%CI：0.5，1.74)、入院(RR=1.05，95%CI：0.80，1.38)和出院存活率(RR=0.69，95%CI：0.48，1.00)无显著影响。结论：院前应用肾上腺素可增加患者院前自主循环恢复，但不能提高总的自主循环复苏率、入院存活率和出院存活率。
Introduction: 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 (Cl) 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% Cl: 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% Cl: 0.5, 1.74), admission (RR=1.05, 95% CI: 0.80, 1.38) and survival to discharge (RR = 0.69, 95% Cl: 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.