Early adrenaline for cardiac arrestBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3245 (Published 29 May 2014) Cite this as: BMJ 2014;348:g3245
- Gavin D Perkins, professor of critical care medicine1,
- Jerry P Nolan, consultant in anaesthesia and intensive care medicine2
- 1University of Warwick and Heart of England NHS Foundation Trust, Coventry CV4 7AL, UK
- 2Royal United Hospital, Bath BA1 3NG, UK
- Correspondence to: G Perkins
Adrenaline (epinephrine) has been used as a treatment for cardiac arrest since the inception of modern day resuscitation. Despite its widespread use, meta-analysis of existing randomised controlled trials has failed to show any effect or benefit on survival to discharge or neurological outcomes.1 Some observational studies have even suggested associated harm.2
In a linked paper, Donnino and colleagues (doi:10.1136/bmj.g3028) explored the effect of timing of delivery of adrenaline during in-hospital cardiac arrest.3 Using data from the American Heart Association Get With The Guidelines registry of in-hospital cardiac arrest, they constructed multivariate logistic regression models to dissect out the effect of early adrenaline on long term outcomes. The analysis focused on a specific cohort of patients—those sustaining a cardiac arrest in hospital with an initial non-shockable rhythm (asystole or pulseless electrical activity (PEA)) on a general hospital ward. It excluded most patients who sustained a cardiac arrest in a specialist clinical area (such as the emergency department or intensive care unit).
Their main finding was a stepwise decrease in hospital survival for every minute that adrenaline delivery was delayed (survival rate of 12% …
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