A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock
Background: Septic shock is associated with significant mortality. The International Surviving Sepsis Campaign guidelines recommend noradrenaline as first-line vasopressor, whilst South African guidelines recommend adrenaline. Clinical trials show similar efficacy but suggest safety advantages for n...
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Elsevier
2025-09-01
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| Series: | African Journal of Emergency Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X25000205 |
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| author | Trudy D Leong Rephaim Mpofu Sumaya Dadan Karen Cohen Halima Dawood Tamara Kredo Andy Parrish Marc Blockman P. Dean Gopalan |
| author_facet | Trudy D Leong Rephaim Mpofu Sumaya Dadan Karen Cohen Halima Dawood Tamara Kredo Andy Parrish Marc Blockman P. Dean Gopalan |
| author_sort | Trudy D Leong |
| collection | DOAJ |
| description | Background: Septic shock is associated with significant mortality. The International Surviving Sepsis Campaign guidelines recommend noradrenaline as first-line vasopressor, whilst 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 (RR) and mean differences (MD) with 95 % confidence intervals and rated certainty of evidence using GRADE. Key outcomes included mortality, time to shock reversal, and adverse effects. (PROSPERO: CRD42022368373).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 to 31.08), vasopressor-free days (MD -0.05 days, -4.07 to 3.96), or dysrhythmias (RR 0.92, 0.59 to 1.45). Change in lactate concentrations 24 h after resuscitation was lower for noradrenaline than adrenaline. The certainty of evidence was assessed as low to very low.Conclusion: Adrenaline and noradrenaline are associated with similar outcomes in managing septic shock. The choice of vasopressor should be based on availability, patient population, and cost. |
| format | Article |
| id | doaj-art-2bcd5ca9d2db47dfbae6e7068e2ce9e6 |
| institution | Matheson Library |
| issn | 2211-419X |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj-art-2bcd5ca9d2db47dfbae6e7068e2ce9e62025-07-02T04:50:18ZengElsevierAfrican Journal of Emergency Medicine2211-419X2025-09-01153100881A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shockTrudy D Leong0Rephaim Mpofu1Sumaya Dadan2Karen Cohen3Halima Dawood4Tamara Kredo5Andy Parrish6Marc Blockman7P. Dean Gopalan8Health Systems Research Unit, South African Medical Research Council, South Africa; South African GRADE Network, South Africa; South African Adult Hospital and Primary Healthcare Expert Review Committee of the National Essential Medicines List Committee, South Africa, 2020-2024; Corresponding author at. Health Systems Research Unit, South African Medical Research Council Francie van Zijl Drive Parow Valley Parow, 7500, South Africa.Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa; South African Adult Hospital and Primary Healthcare Expert Review Committee of the National Essential Medicines List Committee, South Africa, 2020-2024Division of Epidemiology and Biostatistics, University of Cape Town, South AfricaSouth African GRADE Network, South Africa; Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa; South African Adult Hospital and Primary Healthcare Expert Review Committee of the National Essential Medicines List Committee, South Africa, 2020-2024; South African National Essential Medicines List Committee, South Africa, 2021-2025South African Adult Hospital and Primary Healthcare Expert Review Committee of the National Essential Medicines List Committee, South Africa, 2020-2024; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, South Africa; Department of Internal Medicine, Grey’s Hospital, Pietermaritzburg, South AfricaHealth Systems Research Unit, South African Medical Research Council, South Africa; South African GRADE Network, South Africa; South African National Essential Medicines List Committee, South Africa, 2021-2025; Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South AfricaSouth African National Essential Medicines List Committee, South Africa, 2021-2025; Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, South AfricaDivision of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa; South African Adult Hospital and Primary Healthcare Expert Review Committee of the National Essential Medicines List Committee, South Africa, 2020-2024; South African National Essential Medicines List Committee, South Africa, 2021-2025South African Adult Hospital and Primary Healthcare Expert Review Committee of the National Essential Medicines List Committee, South Africa, 2020-2024; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu Natal, South AfricaBackground: Septic shock is associated with significant mortality. The International Surviving Sepsis Campaign guidelines recommend noradrenaline as first-line vasopressor, whilst 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 (RR) and mean differences (MD) with 95 % confidence intervals and rated certainty of evidence using GRADE. Key outcomes included mortality, time to shock reversal, and adverse effects. (PROSPERO: CRD42022368373).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 to 31.08), vasopressor-free days (MD -0.05 days, -4.07 to 3.96), or dysrhythmias (RR 0.92, 0.59 to 1.45). Change in lactate concentrations 24 h after resuscitation was lower for noradrenaline than adrenaline. The certainty of evidence was assessed as low to very low.Conclusion: Adrenaline and noradrenaline are associated with similar outcomes in managing septic shock. The choice of vasopressor should be based on availability, patient population, and cost.http://www.sciencedirect.com/science/article/pii/S2211419X25000205Septic shockAdrenalineNoradrenalineMortalityDysrhythmiasLactate |
| spellingShingle | Trudy D Leong Rephaim Mpofu Sumaya Dadan Karen Cohen Halima Dawood Tamara Kredo Andy Parrish Marc Blockman P. Dean Gopalan A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock African Journal of Emergency Medicine Septic shock Adrenaline Noradrenaline Mortality Dysrhythmias Lactate |
| title | A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock |
| title_full | A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock |
| title_fullStr | A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock |
| title_full_unstemmed | A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock |
| title_short | A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock |
| title_sort | systematic review and meta analysis of noradrenaline compared to adrenaline in the management of septic shock |
| topic | Septic shock Adrenaline Noradrenaline Mortality Dysrhythmias Lactate |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X25000205 |
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