Abstracts from international Emergency Medicine journals

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication. TThe official journal of the African Federation for Emergency Medicine, the Emergency Medicine Association of Tanzania, the Emergency Medicine Society of South Africa, the Egyptian Society of Emergency Medicine, the Libyan Emergency Medicine Association, the Ethiopian Society of Emergency Medicine Professionals, the Sudanese Emergency Medicine Society, the Society of Emergency Medicine Practitioners of Nigeria and the Rwanda Emergency Care Association. ### A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock Leong, T. D., Mpofu, R., Dadan, S., Cohen, K., Dawood, H., Kredo, T., Parrish, A., Blockman, M., & Gopalan, P. D. Background: Septic shock is associated with significant mortality. The International Surviving Sepsis Campaign guidelines recommend noradrenaline as first-line vasopressor, while South African guidelines recommend adrenaline. Clinical trials show similar efficacy but suggest safety advantages for noradrenaline. We reviewed the evidence comparing noradrenaline and adrenaline in the initial management of adult patients with septic shock. Methods: We searched PubMed, Epistemonikos, Cochrane Library and clinical trial registries for clinical practice guidelines, health technology assessments and systematic reviews of randomised controlled trials (RCTs) through July 2024. We appraised these using AGREE II and AMSTAR 2 tools and assessed eligible RCTs extracted from systematic reviews with Cochrane's Risk of Bias 2.0 Tool. We estimated random-effects rate ratios (RRs) and mean differences (MDs) with 95% CIs and rated certainty of evidence using GRADE. Key outcomes included mortality, time to shock reversal and adverse effects. (PROSPERO: CRD42022368373). ![Graphic][1]</img> Results: We identified three guidelines, one systematic review, from which five RCTs were extracted. Comparing adrenaline to noradrenaline, we found little to no difference in mortality (RR 0.99, 0.83 to 1.18), time to improvement of mean arterial pressure (MD 7.17 min, −16.74 … [1]: /embed/inline-graphic-1.gif