TY - JOUR
T1 - Effect of continuous epinephrine infusion on survival in critically ill patients
T2 - A meta-analysis of randomized trials
AU - Belletti, Alessandro
AU - Nagy, Adam
AU - Sartorelli, Marianna
AU - Mucchetti, Marta
AU - Putzu, Alessandro
AU - Sartini, Chiara
AU - Morselli, Federica
AU - de Domenico, Pierfrancesco
AU - Zangrillo, Alberto
AU - Landoni, Giovanni
AU - Lembo, Rosalba
N1 - Publisher Copyright:
© 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020
Y1 - 2020
N2 - Objectives: Epinephrine is frequently used as an inotropic and vasopressor agent in critically ill patients requiring hemodynamic support. Data from observational trials suggested that epinephrine use is associated with a worse outcome as compared with other adrenergic and nonadrenergic vasoactive drugs. We performed a systematic review and meta-analysis of randomized controlled trials to investigate the effect of epinephrine administration on outcome of critically ill patients. Data Sources: PubMed, EMBASE, and Cochrane central register were searched by two independent investigators up to March 2019. Study Selection: Inclusion criteria were: administration of epinephrine as IV continuous infusion, patients admitted to an ICU or undergoing major surgery, and randomized controlled trials. Studies on epinephrine administration as bolus (e.g., during cardiopulmonary resuscitation), were excluded. The primary outcome was mortality at the longest follow-up available. Data Extraction: Two independent investigators examined and extracted data from eligible trials. Data Synthesis: A total of 5,249 studies were assessed, with a total of 12 studies (1,227 patients) finally included in the meta-analysis. The majority of the trials were performed in the setting of septic shock, and the most frequent comparator was a combination of norepinephrine plus dobutamine. We found no difference in all-cause mortality at the longest follow-up available (197/579 [34.0%] in the epinephrine group vs 219/648 [33.8%] in the control group; risk ratio = 0.95; 95% CI, 0.82-1.10; p = 0.49; I2 = 0%). No differences in the need for renal replacement therapy, occurrence rate of myocardial ischemia, occurrence rate of arrhythmias, and length of ICU stay were observed. Conclusions: Current randomized evidence showed that continuous IV administration of epinephrine as inotropic/vasopressor agent is not associated with a worse outcome in critically ill patients.
AB - Objectives: Epinephrine is frequently used as an inotropic and vasopressor agent in critically ill patients requiring hemodynamic support. Data from observational trials suggested that epinephrine use is associated with a worse outcome as compared with other adrenergic and nonadrenergic vasoactive drugs. We performed a systematic review and meta-analysis of randomized controlled trials to investigate the effect of epinephrine administration on outcome of critically ill patients. Data Sources: PubMed, EMBASE, and Cochrane central register were searched by two independent investigators up to March 2019. Study Selection: Inclusion criteria were: administration of epinephrine as IV continuous infusion, patients admitted to an ICU or undergoing major surgery, and randomized controlled trials. Studies on epinephrine administration as bolus (e.g., during cardiopulmonary resuscitation), were excluded. The primary outcome was mortality at the longest follow-up available. Data Extraction: Two independent investigators examined and extracted data from eligible trials. Data Synthesis: A total of 5,249 studies were assessed, with a total of 12 studies (1,227 patients) finally included in the meta-analysis. The majority of the trials were performed in the setting of septic shock, and the most frequent comparator was a combination of norepinephrine plus dobutamine. We found no difference in all-cause mortality at the longest follow-up available (197/579 [34.0%] in the epinephrine group vs 219/648 [33.8%] in the control group; risk ratio = 0.95; 95% CI, 0.82-1.10; p = 0.49; I2 = 0%). No differences in the need for renal replacement therapy, occurrence rate of myocardial ischemia, occurrence rate of arrhythmias, and length of ICU stay were observed. Conclusions: Current randomized evidence showed that continuous IV administration of epinephrine as inotropic/vasopressor agent is not associated with a worse outcome in critically ill patients.
KW - Catecholamines
KW - Hemodynamic management
KW - Inotropes
KW - Intensive care unit
KW - Shock
KW - Vasopressors
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U2 - 10.1097/CCM.0000000000004127
DO - 10.1097/CCM.0000000000004127
M3 - Review article
C2 - 31789701
AN - SCOPUS:85079343181
SP - 398
EP - 405
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
ER -