A study in the November 25 issue of JAMA has demonstrated that patients with an out-of-hospital cardiac arrest who received intravenous (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.

"Intravenous 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 write. "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, M.D., of Oslo University Hospital, Norway, and colleagues compared outcomes for patients receiving standard ACLS with and without intravenous drug administration during out-of-hospital cardiac arrest in Oslo, between May 2003 and April 2008. Of 1,183 patients for whom resuscitation was attempted, 851 were included 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. The primary outcome for the study was survival to hospital discharge, with other outcomes including 1-year survival and quality of CPR (chest compression rate, pauses, and ventilation rate).