Recent reviews of published evidence on the use of vasopressors in the treatment of out-of-hospital cardiac arrest (OHCA) have concluded that administration of adrenaline increases the rate of short-term survival, as measured by return of spontaneous circulation but may cause worse long-term patient outcomes 1-3.
The treatment recommendation on the use of vasopressors in cardiac arrest, published in 2010 by the International Liaison Committee on Resuscitation (ILCOR), stated: 'Although there is evidence that vasopressors (adrenaline or vasopressin) may improve return of spontaneous circulation (ROSC) and short-term survival, there is insufficient evidence to suggest that vasopressors improve survival to discharge and neurological outcome. There is insufficient evidence to suggest the optimal dosage of any vasopressor in the treatment of adult cardiac arrest. Given the observed benefit in short-term outcomes, the use of adrenaline or vasopressin may be considered in adult cardiac arrest'4.
ILCOR stated that 'Placebo-controlled trials to evaluate the use of any vasopressor in adult and paediatric cardiac arrest are needed'
The current Resuscitation Council (UK) Guidelines and the UK Ambulance Services Clinical Practice Guidelines include the recommendation that adrenaline is given routinely every 3-5 minutes during the management of cardiac arrest. The long-term safety and effectiveness of this recommendation is unknown. The Resuscitation Council (UK) supports the need for a randomised, controlled trial of adrenaline versus placebo in adults sustaining out-of-hospital cardiac arrest. In the context of such a trial, comparing adrenaline with placebo is considered ethically justified.
May 2013
References:
- Callaway CW. Epinephrine for cardiac arrest. Curr Opin Cardiol. 2013; 28(1): 36-42.
- Miller C. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: the use of adrenaline and long-term survival in cardiopulmonary resuscitation following cardiac arrest. Emerg Med J. 2013; 30(3): 249-50
- Nolan JP, Perkins GD. Is there a role for adrenaline during cardiopulmonary resuscitation? Curr Opin Crit Care. 2013; 19: In press
- Deakin CD, Morrison LJ, Morley PT, Callaway CW, Kerber RE, Kronick SL, et al. Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2010; 81(1, Supplement 1): e93-e174
