title: Effects of adrenaline on rhythm transitions in out-of-hospital cardiac arrest.
abstract: BACKGROUND
  We wanted to study the effects of intravenous (i.v.) adrenaline (epinephrine) on rhythm transitions during cardiac arrest with initial or secondary ventricular fibrillation/tachycardia (VF/VT).
  
  
  METHODS
  Post hoc analysis of patients included in a randomised controlled trial of i.v. drugs in adult, non-traumatic out-of-hospital cardiac arrest patients who were defibrillated and had a readable electrocardiography recording. Patients who received adrenaline were compared with patients who did not. Cardiac rhythms were annotated manually using the defibrillator data.
  
  
  RESULTS
  Eight hundred and forty-nine patients were included in the randomised trial of which 223 were included in this analysis; 119 in the adrenaline group and 104 in the no-adrenaline group. The proportion of patients with one or more VF/VT episodes after temporary return of spontaneous circulation (ROSC) was higher in the adrenaline than in the no-adrenaline group, 24% vs. 12%, P = 0.03. Most relapses from ROSC to VF/VT in the no-adrenaline group occurred during the first 20 min of resuscitation, whereas patients in the adrenaline group experienced such relapses even after 20 min. Fibrillations from asystole or pulseless electrical activity, shock resistant VF/VT and the number of rhythm transitions per patient was higher in the adrenalin group compared with the no-adrenalin group: 90% vs. 69%, P < 0.001; 46% vs. 33%, P = 0.006; median 8 (5,13) vs. 2 (1,5), P < 0.001, respectively.
  
  
  CONCLUSIONS
  Patients who received adrenaline had more rhythm transitions from ROSC and non-shockable rhythms to VF/VT.
authors.affiliation: Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors.forename: Andres
authors.initials: A
authors.lastname: Neset
authors.forename: Trond
authors.initials: T
authors.lastname: Nordseth
authors.forename: Jo
authors.initials: J
authors.lastname: Kramer-Johansen
authors.forename: Lars
authors.initials: L
authors.lastname: Wik
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Olasveengen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004554:Electric Countershock; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008021:Life Support Systems; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy* / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000188:drug therapy; D014693:Ventricular Fibrillation / Q000188:drug therapy
chemical_list: D004837:Epinephrine