Adrenaline Still Recommended for Use in Cardiac Arrest

A new study provides the best evidence to date supporting the continued use of adrenaline to treat cardiac arrest, despite limited evidence for or against its use.

Researchers at St John Ambulance (Belmont, Australia) and the University of Western Australia (Perth, Australia) conducted a randomized double-blind placebo-controlled trial involving 601 out-of-hospital cardiac arrest victims who were randomized to receive either placebo (0.9% sodium chloride) or 1:1,000 adrenaline during advanced life support, according to current advanced life support guidelines. The groups were well matched for baseline characteristics including age, gender, and receiving bystander cardiopulmonary resuscitation (CPR). Outcomes assessed included survival to hospital discharge (primary outcome), prehospital return of spontaneous circulation (ROSC), and neurological outcome as measured using the cerebral performance category (CPC) score.

Documentation was available for a total of 534 of the patients--262 in the placebo group and 272 in the adrenaline group. The results showed that survival to hospital discharge occurred in 5 (1.9%) and 11 (4.0%) patients receiving placebo or adrenaline (respectively); all but 2 patients (both in the adrenaline group) had a CPC score of 1-2. In all, the results showed no difference in the primary end study point--survival to hospital discharge--but did show that ROSC occurred three times more commonly with adrenaline (23.5%) than with saline placebo (8.4%). The study was published early online on July 2, 2011, in Resuscitation.

“Our study highlights the significant challenges in undertaking randomized trials in cardiac arrest, particularly when it involves accepted but unproven therapy,” said lead author Prof. Ian Jacobs, PhD, and colleagues of the department of emergency medicine. “Although we were unable to demonstrate that adrenaline improved the chance of surviving to hospital discharge, adrenaline did increase the likelihood of restoring circulation following cardiac arrest.”

Related Links:
St John Ambulance
University of Western Australia