ADRENALINE IN OUT-OF-HOSPITAL VENTRICULAR-FIBRILLATION - DOES IT MAKEANY DIFFERENCE

Background: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, t he exact role of treatment with adrenaline in these patients remains t o be determined. Aim: To describe the proportion of patients with witn essed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with adrenaline prior to hospital admission. Patien ts and treatment: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Goteborg between 1981 and 1992 i n whom cardiopulmonary resuscitation (CPR) was initiated by our emerge ncy medical service (EMS). During the observation period, some of the EMS staff were authorised to give medication and some were not. Result s: In all, 1360 patients were found in ventricular fibrillation and de tailed information was available in 1203 cases (88%). Adrenaline was g iven in 417 cases (35%). Among patients with sustained ventricular fib rillation, those who received adrenaline experienced the return of spo ntaneous circulation more frequently (P < 0.001) and were hospitalized alive more frequently (P < 0.01). However, the rate of discharge from hospital did not differ significantly between the 2 groups. Among pat ients who converted to asystole or electromechanical dissociation, tho se who received adrenaline experienced the return of spontaneous circu lation more frequently (P < 0.001) and were hospitalised alive more fr equently (P < 0.001). However, the rate of discharge from hospital did not differ significantly between the 2 groups. Conclusions: On the ba sis of 2 treatment regimens during a 12-year survey, we explored the u sefulness of adrenaline in out-of-hospital ventricular fibrillation. B oth patients with sustained ventricular fibrillation and those who con verted to asystole or electromechanical dissociation had an initially more favourable outcome if treated with adrenaline. However, the final outcome was not significantly affected. This study does not confirm t he hypothesis that adrenaline increases survival among patients with o ut-of-hospital cardiac arrest who are found in ventricular fibrillatio n.