Resuscitation
Volume 82, Issue 9 , Pages 1138-1143, September 2011

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

  • Ian G. Jacobs

      Affiliations

    • Discipline of Emergency Medicine (M516), University of Western Australia, 35 Stirling Highway, Crawley, 6009 Western Australia, Australia
    • St John Ambulance (Western Australia), PO Box 183, Belmont 6984, Western Australia, Australia
    • Corresponding Author InformationCorresponding author at: Discipline of Emergency Medicine (M516), University of Western Australia, 35 Stirling Hwy, Crawley, 6009 Western Australia, Australia. Tel.: +61 418 916 261.
    • ,
  • Judith C. Finn

      Affiliations

    • Discipline of Emergency Medicine (M516), University of Western Australia, 35 Stirling Highway, Crawley, 6009 Western Australia, Australia
    • St John Ambulance (Western Australia), PO Box 183, Belmont 6984, Western Australia, Australia
    • ,
  • George A. Jelinek

      Affiliations

    • Department of Medicine, University of Melbourne (St Vincents Hospital), Victoria Parade, Fitzroy, 3065 Melbourne, Australia
    • ,
  • Harry F. Oxer

      Affiliations

    • St John Ambulance (Western Australia), PO Box 183, Belmont 6984, Western Australia, Australia
    • ,
  • Peter L. Thompson

      Affiliations

    • School of Medicine and Population Health, University of Western Australia, Western Australia, Australia
    • Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, 6009 Western Australia, Australia

Received 19 June 2011; received in revised form 22 June 2011; accepted 24 June 2011. published online 04 July 2011.

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 1ml 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.

Keywords: Adrenaline, Out of hospital cardiac arrest, Randomised controlled trial, Survival, Ambulance

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☆ A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.06.029.

PII: S0300-9572(11)00405-9

doi:10.1016/j.resuscitation.2011.06.029

Resuscitation
Volume 82, Issue 9 , Pages 1138-1143, September 2011

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