NEW YORK (Reuters Health) – Giving intravenous drugs during out-of-hospital cardiac arrest does not improve survival, according to a study in the Journal of the American Medical Association for November 25.

The authors of the Norwegian study report that although Advanced Cardiac Life Support (ACLS) guidelines call for paramedics to administer IV drugs during an out-of-hospital cardiac arrest, “these nearly universally applied interventions were not associated with a statistically significant improvement in survival to hospital discharge.”

In a prospective, randomized, single-center trial, Dr. Theresa M. Olasveengen and associates at Oslo University Hospital randomized 851 adults with nontraumatic out-of-hospital cardiac arrest to treatment with standard ACLS, including IV drug administration, or ACLS without IV drugs.

The 418 patients in the IV group were treated with epinephrine (79%), atropine (46%), and amiodarone (17%). In the no-IV group, 9%, 5%, and 4% received epinephrine, atropine and amiodarone, respectively, after restoration of spontaneous circulation.

Forty percent of patients in the IV group achieved return of spontaneous circulation, compared to 25% in the no-IV group (OR, 1.11265, p < 0.001). However, rates of survival to hospital discharge did not differ between groups (10.5% vs 9.2%), nor did survival at 7 days, 1 month, or 1 year.

The authors also note that obtaining IV access and administering the drugs had no effect on the quality of resuscitation efforts. CPR was of good quality, with few pauses, in both groups.

However, the researchers admit, “a type II error cannot be ruled out…. A (larger) study…could be positive for IV access and drug administration.”

They continue, “At a minimum, our results indicate that clinical equipoise exists on the efficacy of IV drugs in the treatment of cardiac arrest and that more definitive trials could be ethically undertaken.”

On the other hand, the investigators conclude, the generally poor survival rates after out-of-hospital cardiac arrest, with or without IV drugs, “indicate that research should be directed at new pharmacological interventions that hold promise of greater effect.”

Reference:
JAMA 2009;302:2222-2229.