Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest

Rachael T. Fothergill; Amber C. Emmerson; Rajeshwari Iyer; Johanna Lazarus; Mark Whitbread; Jerry P. Nolan; Charles D. Deakin; Gavin D. Perkins

doi:10.1016/j.resuscitation.2019.01.022

Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest

Rachael T. Fothergill^*, Amber C. Emmerson, Rajeshwari Iyer, Johanna Lazarus, Mark Whitbread, Jerry P. Nolan, Charles D. Deakin, Gavin D. Perkins

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

13 Citations (Scopus)

280 Downloads (Pure)

Abstract

Background:

Adrenaline is the primary drug of choice for resuscitation from out-of-hospital cardiac arrest (OHCA). Although adrenaline may increase the chance of achieving return of spontaneous circulation (ROSC), there is limited evidence that repeated doses of adrenaline improves overall survival, and increasing evidence of a detrimental effect on neurological function in survivors. This paper reports the relationship between repeated doses of adrenaline and survival in a cohort of patients attended by the London Ambulance Service in the United Kingdom.

Methods:

A retrospective review of OHCA treated by the London Ambulance Service over a one year period. Patients aged ≥18 years who received one or more doses of adrenaline (1 mg bolus) during resuscitation were included in the analyses. Outcomes described are survival to hospital discharge and survival to one year post-arrest.

Results:

Over the one year study period, 3151 patients received adrenaline during OHCA. A significant inverse relationship was found between increasing cumulative doses of adrenaline and survival both to hospital discharge and one year post-arrest. No patients survived after receiving more than ten adrenaline doses. Conclusion: Our study indicates that repeated doses of adrenaline are associated with decreasing odds of survival. There were no survivors amongst patients requiring more than 10 doses of adrenaline.

Original language	English
Pages (from-to)	316-321
Number of pages	6
Journal	Resuscitation
Volume	138
Early online date	29 Jan 2019
DOIs	https://doi.org/10.1016/j.resuscitation.2019.01.022
Publication status	Published - 1 May 2019

Keywords

Adrenaline
Epinephrine
Out-of-hospital cardiac arrest
Prehospital
Repeated adrenaline doses
Resuscitation

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title = "Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest",

abstract = "Background: Adrenaline is the primary drug of choice for resuscitation from out-of-hospital cardiac arrest (OHCA). Although adrenaline may increase the chance of achieving return of spontaneous circulation (ROSC), there is limited evidence that repeated doses of adrenaline improves overall survival, and increasing evidence of a detrimental effect on neurological function in survivors. This paper reports the relationship between repeated doses of adrenaline and survival in a cohort of patients attended by the London Ambulance Service in the United Kingdom. Methods: A retrospective review of OHCA treated by the London Ambulance Service over a one year period. Patients aged ≥18 years who received one or more doses of adrenaline (1 mg bolus) during resuscitation were included in the analyses. Outcomes described are survival to hospital discharge and survival to one year post-arrest. Results: Over the one year study period, 3151 patients received adrenaline during OHCA. A significant inverse relationship was found between increasing cumulative doses of adrenaline and survival both to hospital discharge and one year post-arrest. No patients survived after receiving more than ten adrenaline doses. Conclusion: Our study indicates that repeated doses of adrenaline are associated with decreasing odds of survival. There were no survivors amongst patients requiring more than 10 doses of adrenaline.",

keywords = "Adrenaline, Epinephrine, Out-of-hospital cardiac arrest, Prehospital, Repeated adrenaline doses, Resuscitation",

author = "Fothergill, {Rachael T.} and Emmerson, {Amber C.} and Rajeshwari Iyer and Johanna Lazarus and Mark Whitbread and Nolan, {Jerry P.} and Deakin, {Charles D.} and Perkins, {Gavin D.}",

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doi = "10.1016/j.resuscitation.2019.01.022",

language = "English",

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T1 - Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest

AU - Fothergill, Rachael T.

AU - Emmerson, Amber C.

AU - Iyer, Rajeshwari

AU - Lazarus, Johanna

AU - Whitbread, Mark

AU - Nolan, Jerry P.

AU - Deakin, Charles D.

AU - Perkins, Gavin D.

PY - 2019/5/1

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N2 - Background: Adrenaline is the primary drug of choice for resuscitation from out-of-hospital cardiac arrest (OHCA). Although adrenaline may increase the chance of achieving return of spontaneous circulation (ROSC), there is limited evidence that repeated doses of adrenaline improves overall survival, and increasing evidence of a detrimental effect on neurological function in survivors. This paper reports the relationship between repeated doses of adrenaline and survival in a cohort of patients attended by the London Ambulance Service in the United Kingdom. Methods: A retrospective review of OHCA treated by the London Ambulance Service over a one year period. Patients aged ≥18 years who received one or more doses of adrenaline (1 mg bolus) during resuscitation were included in the analyses. Outcomes described are survival to hospital discharge and survival to one year post-arrest. Results: Over the one year study period, 3151 patients received adrenaline during OHCA. A significant inverse relationship was found between increasing cumulative doses of adrenaline and survival both to hospital discharge and one year post-arrest. No patients survived after receiving more than ten adrenaline doses. Conclusion: Our study indicates that repeated doses of adrenaline are associated with decreasing odds of survival. There were no survivors amongst patients requiring more than 10 doses of adrenaline.

AB - Background: Adrenaline is the primary drug of choice for resuscitation from out-of-hospital cardiac arrest (OHCA). Although adrenaline may increase the chance of achieving return of spontaneous circulation (ROSC), there is limited evidence that repeated doses of adrenaline improves overall survival, and increasing evidence of a detrimental effect on neurological function in survivors. This paper reports the relationship between repeated doses of adrenaline and survival in a cohort of patients attended by the London Ambulance Service in the United Kingdom. Methods: A retrospective review of OHCA treated by the London Ambulance Service over a one year period. Patients aged ≥18 years who received one or more doses of adrenaline (1 mg bolus) during resuscitation were included in the analyses. Outcomes described are survival to hospital discharge and survival to one year post-arrest. Results: Over the one year study period, 3151 patients received adrenaline during OHCA. A significant inverse relationship was found between increasing cumulative doses of adrenaline and survival both to hospital discharge and one year post-arrest. No patients survived after receiving more than ten adrenaline doses. Conclusion: Our study indicates that repeated doses of adrenaline are associated with decreasing odds of survival. There were no survivors amongst patients requiring more than 10 doses of adrenaline.

KW - Adrenaline

KW - Epinephrine

KW - Out-of-hospital cardiac arrest

KW - Prehospital

KW - Repeated adrenaline doses

KW - Resuscitation

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JO - Resuscitation

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ER -

Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest

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