Adrenaline in out-of-hospital ventricular fibrillation. Does it make any difference?

Epinephrine in out-of-hospital cardiac arrest:A critical review

“…The earliest studies assessing the effect of epinephrine in adult out-of-hospital cardiac arrest were observational studies[26–28] that examined differences in ROSC, survival, and neurological outcomes between OHCA patients treated with epinephrine and those not treated with epinephrine, within the same study population. The study by Holmberg et al[27] demonstrated an association of decreased survival with the use of epinephrine ( OR 0.43, 95% CI 0.27–0.66).…”

“…Wang et al[28] produced a similar association with a reported increased mortality ( HR 1.57, 95% CI 1.20–2.07) using a multi-variable regression analysis of epinephrine administration in OHCA. Although Herlitz and colleagues[26] found a comparable decrease in survival to the previous two studies ( RR 1.58, P <0.01), they also found an increased rate of ROSC in patients with sustained VF who had received 3 defibrillatory shocks ( RR 2.0, P <0.001) and in those who converted from VF to either asystole or electromechanical dissociation at any time during resuscitation ( RR 1.76, P <0.001). However, for these studies, the untreated control groups were not case matched and were statistically different in areas such as arrival of paramedics, nurse present, use of lidocaine, and number of shocks administered.…”

“…[16,17,23,27] However, the clinical significance of this outcome is uncertain with a number of studies reporting either no improvement or a decrease in survival to hospital discharge or a decrease in favourable neurological outcome. [18,19,26,30]…”

Vasopressors for cardiopulmonary resuscitation

“…High doses do not seem to improve survival and may increase adverse effects (Ditchey and Lindenfeld 1988;Lindner et al 1991b;Lindner et al 1991a;Hornchen et al 1993;Hilwig et al 2000;Voelckel et al 2000). These concerns have been upheld by the results of several clinical trials (Marwick et al 1988;Olson et al 1989;Herlitz et al 1995;Woodhouse et al 1995;Sherman et al 1997;Behringer et al 1998;Holmberg et al 2002) This paper will review the evidence for and against the use of adrenaline for resuscitation. The focus will be on the pharmacological basis for the use of various agents and how this translates into success in the clinical setting.…”

“…Adrenaline was given to 35% of patients and did not result in any change in the survival of patients to hospital discharge compared with untreated patients. However, as the authors conceded the trial was not randomised, and a major confounding factor was that the patients treated with adrenaline were generally those who presented with more complicated clinical conditions (Herlitz et al 1995) A later, larger (10966 patients) prospective evaluation of adrenaline in CPR was carried out by the same group of researchers. A more clinically useful endpoint, survival to 1 month after cardiac arrest, was employed.…”