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High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest
1Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia.
Insights
High-dose adrenaline (10 mg) showed a significant change to beneficial heart rhythms in cardiac arrest patients but did not improve survival rates compared to placebo or low-dose adrenaline.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Trials
Background:
- Cardiac arrest management guidelines recommend adrenaline administration.
- Optimal adrenaline dosing strategies for cardiac arrest remain under investigation.
- Previous studies suggest potential benefits of higher adrenaline doses.
Purpose of the Study:
- To compare the efficacy of blinded 10 mg adrenaline aliquots versus placebo in cardiac arrest patients.
- To analyze the impact of different adrenaline doses (1 mg vs. 10 mg) on rhythm changes and survival outcomes.
- To evaluate survival rates and hospital discharge in cardiac arrest patients receiving varying adrenaline doses.
Main Methods:
- A randomized controlled trial involving 194 cardiac arrest patients.
- Comparison of blinded 10 mg adrenaline aliquots against placebo.
- Inclusion of in-hospital and out-of-hospital cardiac arrests.
- Analysis of a non-randomized group receiving open 1 mg adrenaline aliquots.
Main Results:
- A significant change to a beneficial rhythm was observed with 10 mg adrenaline (P = 0.01), but not with 1 mg or placebo.
- No significant differences in immediate survival or hospital discharge rates were found between the 10 mg, 1 mg, or placebo groups.
- Patients receiving adrenaline had uniformly poor immediate survival (8.8%) and hospital discharge rates (0.9%).
Conclusions:
- While 10 mg adrenaline may influence heart rhythms beneficially, it does not improve immediate survival or hospital discharge rates in cardiac arrest patients.
- Current evidence suggests that neither 1 mg nor 10 mg adrenaline dosing influences patient outcomes compared to placebo.
- Further research is needed to optimize resuscitation protocols and improve survival rates in cardiac arrest.
Abstract:
This trial compared blinded 10 mg aliquots of adrenaline with placebo in 194 cardiac arrest patients treated in hospital using American Heart Association guidelines. In-hospital and out-of-hospital arrests were included. Of the 339 eligible patients a large proportion (145 (45%)) were not randomised and received open 1 mg aliquots of adrenaline. This group is also analysed. Supervising physicians gave significant preference for males, patients with no previous cardiac history and without multiple organ disease to be given open 1 mg adrenaline. Patients in asystole at the time of consideration for entry were preferentially placed in the trial group (114 (69%) vs. 170 (88%)) and patients in ventricular fibrillation were preferentially given open 1 mg adrenaline (31 (21%) vs. 24 (12%) P < 0.03). The most beneficial rhythm changes which led to survival were sinus rhythm and ventricular tachycardia. Analysis of rhythm changes resulting from the dosing showed a significant (P = 0.01) change to a beneficial rhythm with 10 mg adrenaline but not for 1 mg adrenaline or placebo. This was not reflected by an improvement in immediate survival. No significant differences in immediate survival (IS) or hospital discharge (HD) exists between open 1 mg adrenaline (IS 14 (9.7%), HD 3 (2%)) or the 10 mg adrenaline (IS 9 (9.6%), HD 0) vs. placebo (IS 7 (7%), HD 0) trial arms. Patients reaching the point of use of adrenaline have a uniformly poor immediate survival (8.8%) and hospital discharge rate (0.9%). Dosing with 10 mg or 1 mg adrenaline does not influence outcome compared with placebo.