Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial

Jacobs, Ian G., Finn, Judith, Jelinek, George A., Oxer, Harry F. and Thompson, Peter L. (2011) Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial. Resuscitation, 82 9: 1138-1143. doi:10.1016/j.resuscitation.2011.06.029


Author Jacobs, Ian G.
Finn, Judith
Jelinek, George A.
Oxer, Harry F.
Thompson, Peter L.
Title Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial
Journal name Resuscitation   Check publisher's open access policy
ISSN 0300-9572
1873-1570
Publication date 2011-09
Sub-type Article (original research)
DOI 10.1016/j.resuscitation.2011.06.029
Open Access Status
Volume 82
Issue 9
Start page 1138
End page 1143
Total pages 6
Place of publication Shannon, Co. Clare, Ireland
Publisher Elsevier
Language eng
Formatted abstract
Background: There is little evidence from clinical trials that the use of adrenaline (epinephrine) in treating cardiac arrest improves survival, despite adrenaline being considered standard of care for many decades. The aim of our study was to determine the effect of adrenaline on patient survival to hospital discharge in out of hospital cardiac arrest.

Methods: We conducted a double blind randomised placebo-controlled trial of adrenaline in out-of-hospital cardiac arrest. Identical study vials containing either adrenaline 1:1000 or placebo (sodium chloride 0.9%) were prepared. Patients were randomly allocated to receive 1 ml aliquots of the trial drug according to current advanced life support guidelines. Outcomes assessed included survival to hospital discharge (primary outcome), pre-hospital return of spontaneous circulation (ROSC) and neurological outcome (Cerebral Performance Category Score – CPC).

Results: A total of 4103 cardiac arrests were screened during the study period of which 601 underwent randomisation. Documentation was available for a total of 534 patients: 262 in the placebo group and 272 in the adrenaline group. Groups were well matched for baseline characteristics including age, gender and receiving bystander CPR. ROSC occurred in 22 (8.4%) of patients receiving placebo and 64 (23.5%) who received adrenaline (OR = 3.4; 95% CI 2.0–5.6). Survival to hospital discharge occurred in 5 (1.9%) and 11 (4.0%) patients receiving placebo or adrenaline respectively (OR = 2.2; 95% CI 0.7–6.3). All but two patients (both in the adrenaline group) had a CPC score of 1–2.

Conclusion: Patients receiving adrenaline during cardiac arrest had no statistically significant improvement in the primary outcome of survival to hospital discharge although there was a significantly improved likelihood of achieving ROSC. 
Keyword Adrenaline
Out of hospital cardiac arrest
Randomised controlled trial
Survival
Ambulance
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
 
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Created: Thu, 17 Jul 2014, 10:34:12 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work