JAMA: Out-of-hospital IV drug does not improve survival for cardiac arrest

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Patients with an out-of-hospital cardiac arrest who received IV drug administration during treatment, recommended in life support guidelines, had higher rates of short-term survival but no statistically significant improvement in survival to hospital discharge or long-term survival, compared to patients who did not receive IV drug administration, according to a study in the Nov. 25 issue of Journal of the American Medical Association.

“IV access and drug administration are integral parts of cardiopulmonary resuscitation [CPR] guidelines. Millions of patients have received epinephrine during advanced cardiac life support [ACLS] with little or no evidence of improved survival to hospital discharge,” the authors wrote. “Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or CPR interruptions secondary to establishing an intravenous line and drug administration.”

Theresa M. Olasveengen, MD, of Oslo University Hospital in Oslo, Norway, and colleagues compared outcomes for patients receiving standard ACLS with and without IV drug administration during out-of-hospital cardiac arrest in Oslo, between May 2003 and April 2008.

Of the 1,183 patients for whom resuscitation was attempted, the researchers included 851 in the study and randomized to either intervention: 418 patients were in the ACLS with intravenous drug administration group and 433 were in the ACLS with no intravenous drug administration group.

According to the authors, the primary outcome for the study was survival to hospital discharge, with other outcomes including one-year survival and quality of CPR (chest compression rate, pauses and ventilation rate).

The researchers noted that an analysis of the study results indicated that both groups had adequate and similar CPR quality, with few chest compression pauses and with compression and ventilation rates within the guideline recommendations.

“In the IV group, 10.5 percent survived to hospital discharge versus 9.2 percent in the no IV group. Survival with favorable neurological outcome was 9.8 percent for the IV group and 8.1 percent for the no intravenous group,” the authors wrote. The cumulative post-cardiac arrest survival rate at seven days was 14.6 percent for patients in the IV group versus 12.8 percent for patients in the no IV group, 11.3 versus 8.8 percent, respectively, at one month, and 9.8 versus 8.4 percent at one year.

Olasveengen and colleagues noted that 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 versus the no intravenous group.

They wrote that larger trials “examining resuscitation without intravenous access and drug administration, as well as of existing or new drugs, appear to be justified.”