Adrenaline, ROSC and survival in patients resuscitated from in-hospital cardiac arrest.

OBJECTIVE: To describe how administration of adrenaline is associated with return of spontaneous circulation (ROSC) and 30-day survival in patients with in-hospital cardiac arrest (IHCA).

DESIGN: Retrospective observational study.

SETTING: Analysis of data extracted from a national cardiac arrest registry.

STUDY POPULATION: Patients >18 years old with IHCA from January 2015 up to June 2017.

OUTCOME MEASURES: Primary outcomes were ROSC and 30-day survival. Secondary outcome was survival to hospital discharge with a good neurologic outcome defined as cerebral performance category (CPC) score 1-2.

RESULTS: Of 6033 patients eligible for inclusion, 4055 (67%) received at least one dose of adrenaline. The rate of ROSC was lower in the adrenaline group (72 vs. 98% for shockable rhythm and 50% versus 65% for non-shockable rhythm; p < 0.0001 for both). Patients who had been treated with adrenaline showed a lower rate of 30-day survival (30 vs. 85% for shockable rhythm and 12 vs. 48% for non-shockable rhythm; p < 0.0001 for both). Survival to hospital discharge with a good neurological outcome was lower in the adrenaline group (22 vs. 80% for shockable rhythm and 8 vs. 41% for non-shockable rhythm; p < 0.0001 for both). There was a marked imbalance between the two groups in median duration of cardiopulmonary resuscitation. Stratification by duration of cardiopulmonary resuscitation attenuated the differences in outcomes between treatment groups and in patients with an initial non-shockable rhythm the association between adrenaline and ROSC was reversed to the benefit for adrenaline.

CONCLUSIONS: In our cohort of 6033 patients retrieved from a national cardiopulmonary resuscitation registry, administration of adrenaline during resuscitation from IHCA was associated with a lower rate of ROSC and 30-day survival.