No advantage seen with IV drugs in out-of-hospital cardiac arrest

Heartwire is reporting a review of Olasveengen TM, Sunde K, Brunborg C, et al. Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA 2009; 302:2222-2229.

Some highlights:

“[A] large randomized trial found that giving IV drugs like epinephrine and atropine in the setting of out-of-hospital cardiac arrest made it more likely that patients would be admitted to the hospital but little difference in whether they survived to discharge.

“That outcome was in spite of their undergoing resuscitation longer and receiving more defibrillations, and more often reattaining a spontaneous circulation, compared with another group that didn’t receive IV drugs during arrest.

“The trial is only the latest of several in recent years to reappraise the efficacy of major elements of conventional cardiopulmonary resuscitation.”

“The message for emergency providers is that, for now, the cornerstones of optimal cardiac resuscitation include high-quality cardiopulmonary resuscitation with minimal interruptions for anything, including any drug administration, and early defibrillation (emphasis added).”

“The quality of delivered cardiopulmonary resuscitation (including chest-compression rate, ventilation rate, and other factors), a prospectively defined secondary end point, was within guidelines and comparable in the two groups […] So was the prevalence of therapeutic hypothermia as part of management, which exceeded 70%. (emphasis added).”


  • Christopher says:

    Is that 9.2% of the original n=433 or of the 29% admitted of that group? If it is of the n=433 then their conclusion makes sense. PowerPoint slides are evil 😉

  • Jesse says:

    Did they really just say that CPR shouldn't be interrupted for early defibrillation? Please tell me I read that wrong.

  • Jesse says:

    Ah. Minimal. Okay, thats better. But still, Im more than a little shocked that the ROSC in the field apparently contributed so little to the end survival rate.Im a relative newbie here, but haven't epi and atropine been standard code blue drugs for years? I mean, if they have such little affect, why did they get implemented in the first place?

  • obxpilot says:

    Jesse, you should go to the AHA website and look up the standards on ACLS and read them, if you haven't already. There is a wealth of information in there that does not make the ACLS textbook. In one of the AHA Statements they discuss medication usage (part 7.2 of management of cardiac arrest – I recommend everyone read these Statements and see some of the thought processes and research involved in why we do things in ACLS. You might be surprised.

  • Jesse says:

    Jeff-I haven't, but I will. Thank you!

  • More proof that our careers center more around preventing cardiac arrest than getting a high percentage of patients who are already in cardiac arrest to walk out of the hospital.

  • Tom B says:

    Hey guys! Sorry I haven't replied (thanks for the input, Jeff) but I've been busy with my final project for the Captain's promotional process. I finally finished it last night, so I should be able to resume my normal blogging activities in the next week or so. Thanks for being patient!Tom

  • Tom B says:

    Andrew Joseph -True enough! But with 10-fold differences in Utstein-survival in major cities across the U.S. we need to do a much better job with our cardiac arrest patients, too!Tom

  • Shaggy says:

    I remember two patients who we got ROSC on before the ACLS drugs went on board, one after I intubated the patient. Of course they seemed unbelievable as good prompt CPR alone cannot obtain ROSC, right? Last night, medic 6 here in Pittsburgh could not get IV access but obtained ROSC before attempting the IO. Fire first responders got there quickly and started efforts. It brings to light why the research is currently placing more emphasis on good continuous CPR over adequately medications.

  • Tom B says:

    Absolutely, Shaggy! We need to do perfect CPR (chest compressions anyway) and we need to get there fast! The chain-of-survival doesn't become strong by itself. It takes conscious effort.Tom

  • Dave says:

    to Jesse

    Of coarse your pt will probably have the best outcome if they get immediate good CPR, early defib if warranted, a good airway, IV with drugs, and now cooling. But what current ACLS is saying is that good quality CPR gets better results than any other single thing we do in arrest. So it’s not saying avoid defib, just minimize the time it takes you to setup and do it.

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