Efficacy of Adrenaline in Cardiac Arrest

The effects of adrenaline on patient outcomes in out-of-hospital cardiac arrest: A systematic review
Introduction: The use of adrenaline in out-of-hospital cardiac arrest (OHCA) has been questioned in regards to its efficacy in improving patient outcomes. A systematic review of the available evidence was conducted.
Method: PubMed, EmBASE, and CINAHL were searched for studies investigating adrenaline in OHCA. Selected publications were reviewed for validity and suitability for local application using the Critical Appraisal Skills Programme checklist.
Results: One randomised controlled trial and five cohort studies were reviewed. Adrenaline was associated with increased rates of return of spontaneous circulation and a time-dependant increase in survival.
Conclusion: There is sufficient evidence to support the use of adrenaline in OHCA, however further high quality clinical trials are required.
  1. Introduction
Cardiac arrest (CA) is a medical emergency in which cardiac output ceases to provide effective circulation (O'Toole, 2013, p. 286). Patients experiencing CA have a considerably poor prognosis. Rates of survival to hospital discharge for out-of-hospital cardiac arrest (OHCA) in Australia are estimated to be 6-13% (Berdowski, Berg, Tijssen, & Koster, 2010, p.1482).   Prompt application of cardiopulmonary resuscitation (CPR) is essential to promote a return of spontaneous circulation (ROSC) and to provide the patient with the best chance of survival (Nolan, Soar, Wenzel, & Paal, 2012, p. 499).
Additional therapies to be used in CPR, when indicated, include defibrillation, airway management, and administration of pharmacological agents (Nolan et al., 2012, p. 502-505). Version 1.0 of the Queensland Ambulance Service Clinical Practice Manual (2011) permits the administration of 1mg of adrenaline to adults experiencing CA, with repeated doses given if considered appropriate. In spite of this current guideline, adrenaline has recently come...