Background
Description of the condition
the review should begin with a brief description, epidemiology of the condition being addressed and its significance.
Description of the intervention
A description of the intervention should place it in the context of any standard or alternative interventions. The role of the comparator intervention in standard practice should be made clear.
How the intervention might work
This section should include the theoretical reasoning why the intervention under review may have an impact on potential recipients. For example, by relating the drug intervention to the biology of the condition. You should refer to a body of evidence such as similar interventions having an impact or identical interventions having an impact on other populations. You must also refer to a body of literature that justifies the possibility of effectiveness.
PICO question being explored
In adults (>16years) receiving out-of-hospital cardiopulmonary resuscitation, does the administration of standard dose of IV Adrenaline compared to placebo or no treamtent increases the rate of pre-hospital ROSC (return of spontaneous circulation) in patients?
Literature
Methods
Types of studies included Randomised controlled trials & Non-ranodmised controlled trials
Types of participants Adults (>16 years)
Types of interventions (include intervention and control) Adrenaline (intervention) Vs Placebo (Control)
Types of outcome measures (ie. Visual analogue 10 point scale) Primary outcome
The rate of return of spontaneous circulation in patients receiving out-of-hospital cardiopulmonary resuscitation.
Inclusion Criteria
Out-of-hospital adult cardiac arrests
Adult cardiopulmonary resuscitation
Randomised controlled trials < 15 years
Non-randomised controlled trials < 15 years
Non-trauamatic cardiac arrest
Adrenaline verse placebo
Adrenaline verse no treatment
Exclusion Criteria
In-hospital cardiac arrest
Emergency Unit cardiac arrest
Pregnant women
Paediactics
Youth under 16 years of age
Traumatic cardiac arrest
Randomised controlled trials >15 years
Non-randomised controlled trials >15 years
Animal studies
Adrenaline in combination with vasopressure verse placebo
High dose Adrinaline (>1mL)
Academic Database Search Table
Name of database Detailed search terms / strategy Number of results obtained
Cochrane Library (adrenaline OR epinephrine) AND (prehospital OR out-of-hospital) AND (cardiac arrest Or heart attack OR heart arrest) 33
MEDLINE (adrenaline OR epinephrine) AND (prehospital OR out-of-hospital) AND (cardiac arrest Or heart attack OR heart arrest) 17
EMBASE (adrenaline OR epinephrine) AND (prehospital OR out-of-hospital) AND (cardiac arrest Or heart attack OR heart arrest) 56
Google Scholar (adrenaline OR epinephrine) AND (prehospital OR out-of-hospital) AND (cardiac arrest Or heart attack OR heart arrest) AND (Randomised-controlled-trials OR RCT) 1 670
PRISMA Flow Diagram (edited version)
Adapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097
Discussion – Critical appraisal and interpretation
Randomisation
Concealment
Baseline similarity
Blinding
Completeness of reporting and follow-up
Intention-to-treat analysis
Summary of risk of bias
Jacobs et al. (2011) Insert study reference Insert study reference Insert study reference
Randomisation +
Concealment +
Baseline similarity ?
Blinding –
Follow-up +
Intention-to-treat analysis +
Key + Low risk of bias – High risk of bias ? Unclear risk of bias
Chance
Confounding
Results
External validity
Limitations
Conclusion
Audit
References