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Evidence

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:

Paramedic 2: Adrenalin Trial

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