Intravenous epinephrine has been part of the guidelines for cardiopulmonary resuscitation since the start. It improves outcome in animal studies, but has never been investigated in a controlled study in humans. Epidemiologic data indicate that it is an independent negative predictor for survival. If this is true in a controlled randomized study, it could be due to effects of the drug itself or more likely due to reduced quality of chest compressions and ventilations due to the time spent on placing an I.V. needle and injecting drugs.
In a randomized, controlled study of all out-of-hospital cardiac arrest patients in Oslo, Norway, half the patients are treated according to the international guidelines for advanced CPR, and the other half according to the same guidelines, except for no I.V. needle or drugs are given until 5 minutes after eventual return of spontaneous circulation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
904
Epinephrine 1 mg is given iv. every 3 min during CPR
An intravenous needle in placed as soon as possible during CPR
Atropine 3 mg iv in initial systole
Ulleval University Hospital
Oslo, Norway
survival to hospital discharge with neurologic outcome
Time frame: discharge from hospital
admit to hospital with spontaneous circulation
Time frame: hospital admission
one year survival with neurologic outcome
Time frame: one year after hospital discharge
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amiodarone 300 mg iv after repeated failed defibrillation attempts