Epinephrine versus standard treatment (norepinephrine/dopamine) as vasopressor therapy in adults with septic shock: A meta-analysis

ABSTRACT

Background. The Surviving Sepsis Campaign guideline recommends the use of norepinephrine or dopamine as vasopressor therapy in septic shock. Epinephrine is suggested as an alternative agent. However, mortality and morbidity data on the use of epinephrine versus other vasopressors remains controversial. Objective. To evaluate the benefits of epinephrine versus standard treatment (norepinephrine/dopamine) in patients with septic shock using 28-day mortality as the primary outcome. Methods. PUBMED, Cochrane Library, clinical trial registries and reference lists were searched for randomized controlled trials (RCTs) comparing epinephrine with standard treatment in adult septic shock patients. Trial authors were contacted for further information. Two reviewers independently evaluated methodological quality and extracted data. Conflicts were resolved by consensus. A random-effects model was used to estimate the relative risk (RR). Results. No significant difference in 28-day mortality (RR = 0.99) and 90-day mortality (RR = 0.99) was found between patients that received epinephrine versus those that received standard treatment. Post-hoc analysis of overall mortality also showed no significant difference between groups. Noted adverse effects include tachycardia and lactic acidosis within the first 24 hours. Beyond that period, no difference was noted between epinephrine and standard treatment. Conclusion. Epinephrine as vasopressor therapy in adult septic shock patients may be as effective as standard treatment in reducing 28-day mortality. However, lack of high quality studies precludes drawing of definite clinical guidelines. Further investigation is warranted.