Adrenaline in out-of-hospital cardiac arrest: is the jury out?

Adrenaline is a hot topic in emergency care in terms of whether its use actually improves survival for patients in cardiac arrest. The aim for this double-blind randomized placebo-controlled trial was to establish the efficacy of adrenaline in out-of-hospital cardiac arrest.

The study's primary outcome measure was survival to hospital discharge with secondary outcomes being prehospital return of spontaneous circulation (ROSC), and the patient's cerebral performance category (CPC) score at hospital discharge (scale ranges from 1 being normal function, through to 5 where the patient is dead).

Initially, it was determined that the study required 2213 patients per group to be adequately powered to detect clinically important treatment effects. To achieve this sample size, the researchers approached five centres within Australia and New Zealand.

However, for various reasons (including negative media coverage and political pressures prior to the commencement of the trial) four of the services did not participate. This resulted in the study becoming a single-centre trial within the ambulance service covering Perth.