Editorials

Early adrenaline for cardiac arrest

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3245 (Published 29 May 2014) Cite this as: BMJ 2014;348:g3245
  1. Gavin D Perkins, professor of critical care medicine1,
  2. Jerry P Nolan, consultant in anaesthesia and intensive care medicine2
  1. 1University of Warwick and Heart of England NHS Foundation Trust, Coventry CV4 7AL, UK
  2. 2Royal United Hospital, Bath BA1 3NG, UK
  1. Correspondence to: G Perkins g.d.perkins{at}warwick.ac.uk

An old and established treatment still waiting for supporting evidence

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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