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Adrenaline in out-of-hospital ventricular fibrillation. Does it make any difference?
J Herlitz1, L Ekström, B Wennerblom
1Division of Cardiology, Sahlgrenska Hospital, Göteborg, Sweden.
Insights
Adrenaline administration in out-of-hospital cardiac arrest due to ventricular fibrillation improved initial survival but did not significantly affect hospital discharge rates. This study questions adrenaline
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Ventricular fibrillation is a primary cause of out-of-hospital cardiac arrest.
- The efficacy of adrenaline in treating these patients requires further clarification.
Purpose of the Study:
- To assess the impact of pre-hospital adrenaline administration on survival and hospital discharge rates.
- To analyze outcomes for patients with ventricular fibrillation experiencing out-of-hospital cardiac arrest.
Main Methods:
- Retrospective analysis of 1203 patients with out-of-hospital cardiac arrest due to ventricular fibrillation (1981-1992).
- Comparison of outcomes between patients receiving adrenaline and those who did not via emergency medical services.
- Inclusion of patients with sustained ventricular fibrillation and those converting to asystole or electromechanical dissociation.
Main Results:
- Adrenaline treatment was associated with a higher rate of return of spontaneous circulation and hospital admission for patients in both sustained ventricular fibrillation and those who converted rhythms.
- No significant difference in hospital discharge rates was observed between adrenaline-treated and non-treated groups.
- Initial positive effects of adrenaline on survival were not sustained through to hospital discharge.
Conclusions:
- While adrenaline improved initial resuscitation success in out-of-hospital cardiac arrest from ventricular fibrillation, it did not enhance long-term survival to discharge.
- The study does not support the hypothesis that adrenaline increases overall survival in this patient population.
- Further research may be needed to optimize resuscitation protocols for out-of-hospital cardiac arrest.
Background:
A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role of treatment with adrenaline in these patients remains to be determined.
Aim:
To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with adrenaline prior to hospital admission.
Patients And Treatment:
All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1981 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not.
Results:
In all, 1360 patients were found in ventricular fibrillation and detailed information was available in 1203 cases (88%). Adrenaline was given in 417 cases (35%). Among patients with sustained ventricular fibrillation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P < 0.001) and were hospitalized alive more frequently (P < 0.01). However, the rate of discharge from hospital did not differ significantly between the 2 groups. Among patients who converted to asystole or electromechanical dissociation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P < 0.001) and were hospitalised alive more frequently (P < 0.001). However, the rate of discharge from hospital did not differ significantly between the 2 groups.
Conclusions:
On the basis of 2 treatment regimens during a 12-year survey, we explored the usefulness of adrenaline in out-of-hospital ventricular fibrillation. Both patients with sustained ventricular fibrillation and those who converted to asystole or electromechanical dissociation had an initially more favourable outcome if treated with adrenaline. However, the final outcome was not significantly affected. This study does not confirm the hypothesis that adrenaline increases survival among patients with out-of-hospital cardiac arrest who are found in ventricular fibrillation.