Adrenaline use in cardiac arrest

July 26, 2011

Oxford, July 26, 2011 - Adrenaline has kept its place in cardiac arrest guidelines despite limited evidence for or against its use. The PACA (Placebo versus Adrenaline versus Cardiac Arrest) study by Jacobs and colleagues, soon to be published in Resuscitation, the official journal of the European Resuscitation Council, provides the best evidence to date supporting the use of adrenaline to treat cardiac arrest.

In this single-centre double blind study, 601 out-of-hospital cardiac arrest victims were randomized to receive either placebo (0.9% sodium chloride) or adrenaline during advanced life support. Data available from 534 patients (262 placebo vs. 272 adrenaline) showed no difference in the primary end study point, survival to hospital discharge, but did show that a spontaneous circulation was restored (in other words the heart was 'restarted') three times more commonly with adrenaline (23.5%) than with saline placebo (8.4%).

Professor Jacobs commented, "Our study highlights the significant challenges in undertaking randomized trials in cardiac arrest, particularly when it involves accepted but unproven therapy. Although we were unable to demonstrate that adrenaline improved the chance of surviving to hospital discharge, adrenaline did increase the likelihood of restoring circulation following cardiac arrest."

Editor-in-Chief of Resuscitation, Dr Jerry Nolan said, "The authors are to be congratulated for undertaking this important study despite the very challenging factors that are inevitable in the out-of-hospital environment. This is the first placebo controlled trial in human cardiac arrest that has shown short term survival benefit for adrenaline."
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The study, "Effect of Adrenaline on Survival in Out-of-Hospital Cardiac Arrest: A Randomized Double-Blind Placebo-Controlled Trial" by Ian G. Jacobs, Judith C, Finn, George A, Jelinek, Harry F, Oxer and Peter L, Thompson can be found in Resuscitation (2011) doi: 10.1016/j.resuscitation.2011.06.029, published by Elsevier.

About Resuscitation

Resuscitation is the official journal of the European Resuscitation Council and is a monthly international and interdisciplinary medical publication and the only journal in the area of cardiopulmonary resuscitation that is general in nature and not specific to a single body system. Resuscitation has an impact factor of 4.177 and is ranked in first position in the Emergency Medicine category of the 2011 Journal Citation Reports published by Thomson Reuters. www.resuscitationjournal.com.

About Elsevier

Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include SciVerse ScienceDirect, SciVerse Scopus, Reaxys, MD Consult and Nursing Consult, which enhance the productivity of science and health professionals, and the SciVal suite and MEDai's Pinpoint Review, which help research and health care institutions deliver better outcomes more cost-effectively.

A global business headquartered in Amsterdam, Elsevier employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC, a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

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