Jacobs

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

Jacobs, Resuscitation, 2011(82):1138-1143

Clinical Question

  • In patients with cardiac arrest does adrenaline, compared to placebo, improve survival to hospital discharge?

Design

  • Randomised controlled trial
  • Double blinded
  • Randomised at time that adrenaline was required

Setting

  • Pre-hospital, Western Australia
  • 11.08.2006. – 30.11.2009.

Population

  • Inclusion: adult patients with out-of-hospital cardiac arrests
  • Exclusion: resuscitation not commenced
  • 534 patients included out of 601 who were randomised

Intervention

  • Adrenaline 1mg every 3 minutes
    • Given after 3rd unsuccessful shock or after establishment of IV access in non-shockable rhythms

Control

  • Placebo
    • Given as per timings of adrenaline

Outcome

  • Primary outcome: survival to hospital discharge
    • 4% in adrenaline group vs. 1.9% in the placebo group (odds ratio 2.2; 95% C.I. 0.7-6.3), P=0.15
  • Secondary outcome:
    • pre-hospital return of spontaneous circulation (ROSC)
      • 25.3% in adrenaline group vs. 8.4% in placebo group, P<0.001
    • cerebral performance category 1 or 2 (Good neurological outcome) in patients that survived to hospital discharge
      • 100% vs. 81.8%, P=0.31

Authors’ Conclusions

  • Adrenaline improves ROSC but failed to improve survival to hospital discharge.

Strengths

  • Randomised
  • Double blinded
  • Only randomised at time of giving adrenaline – the population studied included only the relevant population

Weaknesses

  • Planned to recruit 5000 patients but only included 534 patients. This was after a number of ambulance services withdrew from the trial following the adverse press reports and political lobbying!
  • Only 16 patients survived to hospital discharge therefore unable to make any definite conclusions

The Bottom Line

  • Adrenaline increased ROSC following cardiac arrest. However there was no improvement in survival to hospital discharge or neurological outcome. Other trials, including the trial by Hagihara¬†have provided some evidence that neurological outcome is worse in patients that are treated with adrenaline. Therefore we need to support a larger trial to determine the final answer.

Links

Full text pdf / abstract / doi: 10.1016/j.resuscitation.2011.06.029

Editorial, Commentaries or Blogs

  • None

Metadata

Summary author: @davidslessor
Summary date: 16 May 2014
Peer-review editor: @stevemathieu75

Leave a Reply