Adrenaline vs placebo or no treatment in out-of-hospital cardiac arrest increases the rate of return of spontanious circulation

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