March - 2012
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Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest.Akihito Hagihara, Manabu Hasegawa, Takeru Abe,et al. JAMA, 2012, 307(11):1161-1168 This page is only available to Crit-IQ subscribers. To view the rest of this review and gain access to our vast array of critical care teaching tools including podcasts, vodcasts, modules, exam preparation tools, teaching aids and much more, login here, or Become a Member to register |
March |
Previous Comments
| This prospective propensity analysis from a large prehospital administrative database raises further doubts about the effectiveness of adrenaline in cardiac arrest. See also the (unfortunately problematic) Australian RCT [Jacobs et al, Resuscitation 82 (2011) 1138 1143] and the Swedish 'drugs vs no drugs' trial [Olasveengen, JAMA. 2009;302(20):2222-2229] Ian Seppelt | |
| Ian Seppelt-26 Mar, 2012 02:03:31 AM | |
| Thanks Ian, Other than the difficulties with recruiting, what were the problems with the Jacobs trial that you mentioned? | |
| Todd Fraser-30 Mar, 2012 07:40:18 AM | |
| At the end of the day this is still an observational trial - you have to wonder in this day and age why patients would not be given adrenaline except in the context of a randomised control trial - so, were the patients who did not received it differ from the other group in some way that affects their outcome? Until a(nother) randomised controlled trial is completed, which now seems unlikely after Jacobs' experience, we will not be able to answer this question. | |
| Darren Cable-30 Mar, 2012 08:03:11 AM | |
Comment
This large Japanese prospective observational OHCA study reports pre-hospital adrenaline is associated with an increase in ROSC, but worse outcomes at 1-month. So they develop the hypothesis that adrenaline gets you to hospital alive, but your survival is worse.
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