BackgroundThe use of adrenaline in out‐of‐hospital cardiac arrest (OHCA) patients is still controversial. This study aimed to determine the effects of early pre‐hospital adrenaline administration in OHCA patients.Methods and ResultsPubMed, EMBASE, Google Scholar, and the Cochrane Library database were searched from study inception to February 2019 to identify studies that reported OHCA patients who received adrenaline. The primary outcome was survival to discharge, and the secondary outcomes were return of spontaneous circulation, favorable neurological outcome, and survival to hospital admission. A total of 574 392 patients were included from 24 studies. The use of early pre‐hospital adrenaline administration in OHCA patients was associated with a significant increase in survival to discharge (risk ratio [RR], 1.62; 95% CI, 1.45–1.83; P<0.001) and return of spontaneous circulation (RR, 1.50; 95% CI, 1.36–1.67; P<0.001), as well as a favorable neurological outcome (RR, 2.09; 95% CI, 1.73–2.52; P<0.001). Patients with shockable rhythm cardiac arrest had a significantly higher rate of survival to discharge (RR, 5.86; 95% CI, 4.25–8.07; P<0.001) and more favorable neurological outcomes (RR, 5.10; 95% CI, 2.90–8.97; P<0.001) than non‐shockable rhythm cardiac arrest patients.ConclusionsEarly pre‐hospital administration of adrenaline to OHCA patients might increase the survival to discharge, return of spontaneous circulation, and favorable neurological outcomes.RegistrationURL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42019130542.

中文翻译：

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肾上腺素在院外心脏骤停的早期管理：系统评价和荟萃分析。

背景：在院外心脏骤停（OHCA）患者中使用肾上腺素仍存在争议。该研究旨在确定早期院前肾上腺素对OHCA患者的治疗效果。方法和结果从研究开始到2019年2月，对PubMed，EMBASE，Google Scholar和Cochrane Library数据库进行搜索，以鉴定报告接受肾上腺素的OHCA患者的研究。主要结局是出院生存，次要结局是自发循环恢复，神经系统结局良好以及入院生存。24项研究共纳入574 392例患者。OHCA患者在院前使用早期肾上腺素可显着提高出院生存率（风险比[RR]为1.62； 95％CI为1.45–1.83；P <0.001）和自然循环恢复（RR，1.50; 95％CI，1.36-1.67; P <0.001），以及良好的神经系统转归（RR，2.09; 95％CI，1.73-2.52; P <0.001 ）。心脏节律性休克的患者有较高的出院生存率（RR，5.86； 95％CI，4.25-8.07；P <0.001），神经系统结局更佳（RR，5.10； 95％CI，2.90-8.97；和（P <0.001），而非心律失常的心脏骤停患者。结论早期在院前向OHCA患者施用肾上腺素可能会增加出院生存率，自发性循环的恢复和良好的神经系统结局。注册网址：https：//www.crd。 york.ac.uk/PROSPERO; 唯一标识符：CRD42019130542。