Adrenaline has kept its place in cardiac arrest guidelines despite limited evidence for or against its use, but the Placebo versus Adrenaline versus Cardiac Arrest (PACA) study provides the best evidence to date supporting the use of adrenaline to treat cardiac arrest.

Researchers headed by Ian Jacobs, PhD, of the University of Western Australia in Perth, conducted the single-center double blind study, in which 601 out-of-hospital cardiac arrest victims were randomized to receive either placebo (0.9% sodium chloride) or adrenaline during advanced life support. Their data is soon to be published in Resuscitation, the official journal of the European Resuscitation Council.

Data available from 534 patients (262 placebo vs. 272 adrenaline) showed no difference in the primary end study point, survival to hospital discharge, but did show that spontaneous circulation was restored three times more often with adrenaline (23.5%) than with saline placebo (8.4%).

“Our study highlights the significant challenges in undertaking randomized trials in cardiac arrest, particularly when it involves accepted but unproven therapy,” Jacobs said in a press release. “Although we were unable to demonstrate that adrenaline improved the chance of surviving to hospital discharge, adrenaline did increase the likelihood of restoring circulation following cardiac arrest.”

“The authors are to be congratulated for undertaking this important study despite the very challenging factors that are inevitable in the out-of-hospital environment,” Jerry Nolan, MD, the journal’s editor in chief, said in the press release. “This is the first placebo controlled trial in human cardiac arrest that has shown short term survival benefit for adrenaline.”

Source

Adrenaline use in cardiac arrest [Resuscitation]