Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation.

BACKGROUND: There is a beneficial effect of adrenaline during adult cardiopulmonary resuscitation (CPR) from cardiac arrest but there is also uncertainty about its safety and effectiveness. The aim of this study was to evaluate the use of adrenaline versus non-adrenaline CPR. METHODS: PubMed, ScienceDirect, Embase, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases were searched from their inception up to 1st July 2020. Two reviewers independently assessed eligibility and risk of bias, with conflicts resolved by a third reviewer. Risk ratio (RR) or mean difference of groups were calculated using fixed or random-effect models. RESULTS: Nineteen trials were identified. The use of adrenaline during CPR was associated with a significantly higher percentage of return of spontaneous circulation (ROSC) compared to non-adrenaline treatment (20.9% vs. 5.9%; RR = 1.87; 95% confidence interval [CI] 1.37-2.55; p < 0.001). The use of adrenaline in CPR was associated with ROSC at 19.4% and for non-adrenaline treatment - 4.3% (RR = 3.23; 95% CI 1.89-5.53; p < 0.001). Survival to discharge (or 30-day survival) when using adrenaline was 6.8% compared to non-adrenaline treatment (5.5%; RR = 0.99; 95% CI 0.76-1.30; p = 0.97). However, the use of adrenaline was associated with a worse neurological outcome (1.6% vs. 2.2%; RR = 0.57; 95% CI 0.42-0.78; p < 0.001). CONCLUSIONS: This review suggests that resuscitation with adrenaline is associated with the ROSC and survival to hospital discharge, but no higher effectiveness was observed at discharge with favorable neurological outcome. The analysis showed higher effectiveness of ROSC and survival to hospital discharge in non-shockable rhythms. But more multicenter randomized controlled trials are needed in the future.

Effect of amiodarone and lidocaine on shock-refractory cardiac arrest: a systematic review and meta-analysis.

BACKGROUND: Appropriate pharmacotherapy during advanced resuscitation procedures may affect the return of spontaneous circulation. Current guidelines on cardiopulmonary resuscitation recommend amiodarone for shock­refractory cardiac arrest or when lidocaine is not available. AIMS: The aim of this study was to systematically analyze the available literature and to conduct a meta­­analysis to determine the effect of amiodarone and lidocaine on survival and neurological outcome after shock­refractory cardiac arrest. METHODS: PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases were searched. Two independent reviewers screened randomized and quasi­randomized controlled trials as well as cohort and cross­sectional trials evaluating amiodarone or lidocaine for the treatment of adults with cardiac arrest. RESULTS: After screening 682 unique references, 8 were selected for this meta­analysis. A higher number of cases with return of spontaneous circulation was observed in the amiodarone group compared with the lidocaine group (OR, 1.03; 95% CI, 0.87-1.21; P = 0.75). A similar relationship was observed for survival to hospital discharge (OR, 1.12; 95% CI, 0.92-1.38; P = 0.26), as well as survival with favorable neurological outcome (OR, 1.11; 95% CI, 0.89-1.39; P = 0.35). CONCLUSIONS: We found no statistically significant survival benefit of resuscitation with amiodarone compared with lidocaine. Future randomized controlled trials are needed to identify which antiarrhythmic drug should be use in shock­refractory cardiac arrest.

Comparison of Direct and Video Laryngoscopes during Different Airway Scenarios Performed by Experienced Paramedics: A Randomized Cross-Over Manikin Study.

Introduction. Airway management plays an essential role in anaesthesia practice, during both elective and urgent surgery procedures and emergency medicine. AIM: The aim of the study was to compare Macintosh laryngoscope (MAC), McGrath, and TruView PCD in 5 separate airway management scenarios. METHODS: This prospective cross-over simulation study involved 93 paramedics. All paramedics performed intubation using direct laryngoscope (MAC), McGrath, and TruView PCD video laryngoscopes. The study was performed in 5 different scenarios: (A) normal airway, (B) tongue oedema, (C) pharyngeal obstruction, (D) cervical collar stabilization with tongue oedema, and (E) cervical collar stabilization with pharyngeal obstruction. RESULTS: In scenario A, the success rate was 99% with MAC, 100% with McGrath, and 94% with PCD. Intubation time was 17 s (IQR: 16-21) for MAC, 18 s (IQR: 16-21) for McGrath, and 27 s (IQR: 23-34) for PCD. In scenario B, the success rate was 61% with MAC, 97% with McGrath, and 97% with PCD (p < 0.001). Intubation time was 44 s (IQR: 24-46) for MAC, 22 s (IQR: 20-27) for McGrath, and 39 s (IQR: 30-57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p < 0.001). Intubation time was 44 s (IQR: 24-46) for MAC, 22 s (IQR: 20-27) for McGrath, and 39 s (IQR: 30-57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p < 0.001). Intubation time was 44 s (IQR: 24-46) for MAC, 22 s (IQR: 20-27) for McGrath, and 39 s (IQR: 30-57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p < 0.001). Intubation time was 44 s (IQR: 24-46) for MAC, 22 s (IQR: 20-27) for McGrath, and 39 s (IQR: 30-57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (. CONCLUSIONS: The McGrath video laryngoscope proved better than Truview PCD and direct intubation with Macintosh laryngoscope in terms of success rate, duration of first intubation attempt, number of intubation attempts, Cormack-Lehane grade, percentage of glottis opening (POGO score), number of optimization manoeuvres, severity of dental compression, and ease of use.