Literature Review for Epinephrine

Primary Outcomes That Matter!

---

Summary of Epinephrine Dose Data

Author	Design	Dose	Outcome
Brown, 1992	RCT n =1280	EPI  0.02 mg/kg (SDA) EPI 0.2 mg/kg (HDA)	No difference in ROSC, Hospital admission, discharge from hospital
Choux, 1995	RCT n = 536	EPI  1 mg (SDA) EPI 5 mg (HDA)	No difference in ROSC, Hospital admission, discharge from hospital, neurological function
Fisk, 2018	Observational n=2255	EPI 1 mg EPI 0.5 mg	No difference in ROSC, discharge from hospital, neurological function
Gueugniaud, 1998	RCT n = 3327	EPI  1 mg (SDA) EPI 5 mg (HDA)	EPI 5 mg ↑ ROSC, ↑ hospital discharge compared to EPI 1 mg No Difference in hospital discharge and neurological function
Stiell, 1992	RCT n = 335	EPI  1 mg (SDA) EPI 7 mg (HDA)	No difference in 1 hr survival, hospital discharge, or neurological function

---

Summary of Epinephrine Efficacy and Safety Data

Author	Year	Design	Outcome (EPI vs Comparator)
Holmberg et al.	2002	Observational	↑ Mortality
Stiell et al. (OPALS)	2004	Observational	↑ ROSC ↔neurological intact survival
Ong et al.	2007	Observational	↔ neurological intact survival
Olasveengen et al.	2009	RCT	↑ ROSC ↔/↑* neurological intact survival
Jacobs et al.	2011	RCT	↑ ROSC ↔ neurological intact survival
Hagihara et al.	2012	Observational	↑ ROSC ↓ neurological intact survival
Nakahara et al.	2013	Observational	↔ neurological intact survival or Mortality
Dumas et al.	2014	Observational	↓ Neuro intact survival
Sanghavi et al.	2015	Observational	↑ Mortality  ↓ Neuro intact survival
Perkins, 2018 (PARAMEDIC-2)	2018	RCT	↓ Mortality ↑ ROSC ↔ neurological intact survival

---

Objective

• In adult patients that present to paramedics with out-of-hospital arrest in the field, does acute cardiac life support performed with epinephrine as compared to placebo lead to improved survival and neurological outcome.

---

Methods

---

Intervention

---

---

PARAMEDIC 2 Results

---

---

Neurologic Impairment

---

Author’s Conclusion

---

Strengths & Limitations