Cardiac Arrest: high-dose adrenaline had no clear effect on survival

Clinical bottom line (level 1b-)

  1. Patients in cardiac arrest who were given 10mg epinephrine had no clear increase in survival than those given placebo.
Woodhouse et al: Resuscitation 1995; 30: 243-249
Expires October 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: city, Australia

194 patients (aged mean 69, 70% male) suffering a cardiac arrest in hospital or out of hospital and reaching the emergency department in asystole or VF.

Excluded if
  • if given standard dose epinephrine
  • premature termination (cancers, severe multiple organ disease, extreme old age)
  • inadequate records
  • previous enrolment in study
  • not in ventricular fibrillation or asystole on arrival at hospital
  • not a primary arrest


    • Note:
  • Patients in VF were shocked twice before randomisation.


    • Control Group: (n = 100, 100 analysed): placebo- saline
    Experimental Group: (n = 94, 94 analysed): 10mg epinephrine iv twice

    100% followed for 60 minutes
    Outcome notes:
    • immediate survival : stable cardiac rhythm with a palpable pulse at the time the cardiac arrest team disbanded

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    immediate survival 60 minutes 7
    (7.00%)    		 9
    (9.56%)    		 37%
    (-47% to 254%)    		 2.57%
    (-5.20% to 10.4%)    		 39
    (NNT = 19 to infinity;
    NNH = 10 to infinity)

  • Groups were initially unbalanced: the epinephrine group had more patients with a cardiac history and multiple organ disease (p<0.01)

    • Comments

    1. The study is too small to show any clear difference between placebo and epinephrine.
    2. No patients were discharged from hospital in the placebo or 10mg epinephrine groups.
    3. Advanced life support followed American Heart Association guidelines except that 2 instead of 3 defibrillations preceded use of epinephrine in ventricular fibrillation.
    4. Only 45% of eligible patients were admitted to the trial.

    Citation

    1. Woodhouse SP, Cox S, Boyd C, et al: High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest.. Resuscitation 1995; 30: 243-249
    Search Terms: epinephr* and arrest in Cochrane
    Contributor: Clare Wotton and Chris Ball, October 1999
    Reviewer: William Rhoton and Martin Dawes

    Clinical Question.
    Patient cardiac arrest
    Intervention or Exposure high dose epinephrine (10mg)
    Comparison placebo
    Outcome survival