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