Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.
BACKGROUND
Intravenous access and drug administration are included in advanced cardiac life support (ACLS) guidelines despite a lack of evidence for improved outcomes. Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or cardiopulmonary resuscitation (CPR) interruptions secondary to establishing an intravenous line and drug administration.


OBJECTIVE
To determine whether removing intravenous drug administration from an ACLS protocol would improve survival to hospital discharge after out-of-hospital cardiac arrest.


METHODS
Prospective, randomized controlled trial of consecutive adult patients with out-of-hospital nontraumatic cardiac arrest treated within the emergency medical service system in Oslo, Norway, between May 1, 2003, and April 28, 2008.


METHODS
Advanced cardiac life support with intravenous drug administration or ACLS without access to intravenous drug administration.


METHODS
The primary outcome was survival to hospital discharge. The secondary outcomes were 1-year survival, survival with favorable neurological outcome, hospital admission with return of spontaneous circulation, and quality of CPR (chest compression rate, pauses, and ventilation rate).


RESULTS
Of 1183 patients for whom resuscitation was attempted, 851 were included; 418 patients were in the ACLS with intravenous drug administration group and 433 were in the ACLS with no access to intravenous drug administration group. The rate of survival to hospital discharge was 10.5% for the intravenous drug administration group and 9.2% for the no intravenous drug administration group (P = .61), 32% vs 21%, respectively, (P<.001) for hospital admission with return of spontaneous circulation, 9.8% vs 8.1% (P = .45) for survival with favorable neurological outcome, and 10% vs 8% (P = .53) for survival at 1 year. The quality of CPR was comparable and within guideline recommendations for both groups. After adjustment for ventricular fibrillation, response interval, witnessed arrest, or arrest in a public location, there was no significant difference in survival to hospital discharge for the intravenous group vs the no intravenous group (adjusted odds ratio, 1.15; 95% confidence interval, 0.69-1.91).


CONCLUSIONS
Compared with patients who received ACLS without intravenous drug administration following out-of-hospital cardiac arrest, patients with intravenous access and drug administration had higher rates of short-term survival with no statistically significant improvement in survival to hospital discharge, quality of CPR, or long-term survival.


BACKGROUND
clinicaltrials.gov Identifier: NCT00121524.
Olasveengen
Theresa M
TM
Institute for Experimental Medical Research, Oslo University Hospital, Ullevaal, N-0407 Oslo, Norway. t.m.olasveengen@medisin.uio.no
Sunde
Kjetil
K
Brunborg
Cathrine
C
Thowsen
Jon
J
Steen
Petter A
PA
Wik
Lars
L
D000322:Adrenergic Agonists / Q000008:administration & dosage*; D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods*; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D015986:Confounding Factors, Epidemiologic; D004632:Emergency Medical Services / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage*; D019317:Evidence-Based Medicine; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009664:Norway; D010351:Patient Discharge; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D004837:Epinephrine