title: Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines.
abstract: BACKGROUND
  Adrenaline does not appear to improve the outcome after cardiac arrest in clinical trials in spite of beneficial effects in experimental studies. The objective of this study was to determine whether adrenaline was administered in accordance with advanced cardiac life support (ACLS) guidelines during adult cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  From 15 January to 31 December 2000, all patients at Uppsala University Hospital in whom CPR was attempted were registered prospectively. The duration of CPR was documented in the register and the total dose of adrenaline was retrieved retrospectively from patient records. From these data the average interval between adrenaline doses was calculated.
  
  
  RESULTS
  Data for evaluation of the between-dose interval of adrenaline was available in 53 of 107 registered cardiac arrests. In 68% (36/53) the average between-dose interval was longer than the 3-5 min recommended in the guidelines, and 8% (4/53) received no adrenaline. The median interval between adrenaline doses during CPR was 6.5 min (25th-75th percentile: 5.1-10.4). Adherence to guidelines was lower in out-of-hospital cardiac arrest than in in-hospital cardiac arrest (P = 0.01).
  
  
  CONCLUSIONS
  In the majority of cases adrenaline did not appear to be administered according to current ACLS guidelines.
authors.affiliation: Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University Hospital, Uppsala, Sweden. jakob.johansson@surgsci.uu.se
authors.forename: J
authors.initials: J
authors.lastname: Johansson
authors.forename: R
authors.initials: R
authors.lastname: Hammerby
authors.forename: J
authors.initials: J
authors.lastname: Oldgren
authors.forename: S
authors.initials: S
authors.lastname: Rubertsson
authors.forename: R
authors.initials: R
authors.lastname: Gedeborg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013997:Time Factors
chemical_list: D004837:Epinephrine