Several research studies have looked at the use of adrenaline as a treatment for cardiac arrest. However, more high-quality evidence is needed to decide whether it should continue to be used in the treatment of cardiac arrest.

Summary of Research

The diagram below shows a summary of the research studies that have looked at the effect of adrenaline on survival to hospital discharge and risk of brain damage:

	Adrenaline made no difference to survival Jacobs et al, 2011	Adrenaline was associated with a worse survival rate Dumas et al, 2014
Adrenaline was associated with a better survival rate in a subgroup with a non-shockable heart rhythm Nakahara et al, 2013	Adrenaline made no difference to survival or to the risk of severe brain damage Machida et al, 2012	Adrenaline was associated with a worse survival rate Herlitz et al, 1995	Adrenaline was associated with a worse survival rate and increased risk of severe brain damage Olasveengen et al, 2012
	Adrenaline made no difference to survival Woodhouse et al, 1995	Adrenaline was associated with a worse survival rate Holmberg et al, 2002	Adrenaline was associated with a worse survival rate and increased risk of severe brain damage Hagihara et al, 2012
	Adrenaline made no difference to survival Ong et al, 2007	Adrenaline made no difference to survival, but increased the risk of severe brain damage Hayashi et al, 2012

As you can see above, only one study showed an increase in survival and therefore a benefit to patients. The rest of the studies show either no difference in the chance of survival or harm when adrenaline is used.

Clinical trial needed

Many international experts have called for a larger clinical trial which can answer the question is adrenaline (epinephrine) helpful or harmful. The articles written about this important question can be read on the following links:

• Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients?
• Epinephrine in Out-of- Hospital Cardiac Arrest
• Epinephrine in out-of-hospital cardiac arrest: A critical review
• Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomised controlled trials
• Effect of epinephrine on survival after cardiac arrest: a systematic review and meta-analysis
• Adrenaline for out of hospital cardiac arrest?
• Is adrenaline safe and effective as a treatment for out of hospital cardiac arrest?

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