Abstract 13: A Prospective Randomized Controlled Trial on the Effects of Intravenous Drug Administration on Survival to Hospital Discharge after Out-of-hospital Cardiac Arrest
Background: Intravenous (IV) epinephrine, atropine and amiodarone are included in CPR guidelines despite lacking evidence for increased survival to hospital discharge, and epinephrine has been associated with decreased survival in epidemiologic studies. Our hypothesis was that IV access and drug administration remove focus from the all important chest compressions, and consequently lead to more chest compression pauses (increased hands-off fraction) and subsequent adverse outcome.
Materials and methods: Patients with non-ambulance witnessed adult out-of-hospital cardiac arrest of all causes (except trauma, anaphylactic shock and asthma induced) in the Oslo and Follo EMS between May 2003 and April 2008 were randomized to receive either standard ACLS (IV group) or ACLS without IV Access (No-IV group). Ambulance run sheets, Utstein forms, Hospital records and continuous ECGs with impedance signals were reviewed. Quality of CPR and clinical outcome was compared between the two groups using Chi square and t-tests as appropriate. Values are given as percentages or means ± standard deviation.
Results: Resuscitation was attempted in 1112 patients of whom 835 were included in the study. There were 415 patients in the IV group and 420 patients in the No-IV group. Utstein variables known to affect survival were equally distributed between the two groups. The CPR quality parameters were adequate, and did not differ between the IV group and the No-IV group with hands-off fractions 0.18±0.11 and 0.17±0.11, compression rates 118±11 and 116±10, and ventilation rates 11±4 and 11±4, respectively. There were 10.6% surviving to hospital discharge in the IV group and 9.0% in the No-IV group (p=0.523).
Conclusion: Quality of CPR was adequate and comparable for both randomization groups. There was no difference in survival to hospital discharge between the IV group and No-IV group.