• Maria Vargas, Pasquale Buonanno, Carmine Iacovazzo, and Giuseppe Servillo.
• Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy. Electronic address: vargas.maria82@gmail.com.
• Resuscitation. 2019 Dec 1; 145: 151-157.

ObjectiveTo evaluate the effectiveness of epinephrine, compared with control treatments, on survival at admission, ROSC, survival to discharge, and a favorable neurologic outcome in adult patients during OHCA.Data SourceMEDLINE and PubMed from inception to August 2018.Study SelectionRandomized controlled trials (RCTs) on adult patients after out-of-hospital cardiac arrest (OHCA) treated with epinephrine versus controls.Data ExtractionIndependent, double-data extraction; risk of bias assessment with Cochrane Collaboration's criteria.Data Synthesis15 RCTs representing 20,716 OHCA adult patients. When epinephrine was compared with a placebo/no drugs, survival to hospital discharge (RR: 1.34, 95% CI: 1.08-1.67), ROSC (RR: 2.03, 95% CI: 1.18-3.51) and survival to hospital admission (RR: 2.04, 95% CI: 1.22-3.43) were increased, but favorable neurologic outcome was not significantly different (RR: 1.22, 95% CI: 0.99-1.51). Patients treated with the high-dose epinephrine (HDE) had a higher rate of ROSC (standard-dose epinephrine (SDE) versus HDE, RR: 0.85, 95% CI: 0.74-0.97, p = 0.01) and increased survival to hospital admission (SDE versus HDE, RR: 0.86, 95% CI: 0.75-0.99, p = 0.04) compared with those treated with SDE. No considered treatments improved the neurological outcome after OHCA.ConclusionsIn OHCA, standard or high doses of epinephrine should be used because they improved survival to hospital discharge. There was also a clear advantage of using epinephrine over a placebo or no drugs in the considered outcomes.Copyright © 2019 Elsevier B.V. All rights reserved.

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