Ian G. Stiell, MD, MSc
In patients with out-of-hospital cardiac arrest, does withholding intravenous (IV) drugs improve outcomes?
Randomized controlled trial. ClinicalTrials.gov NCT00121524.
916 patients ≥ 18 years of age who had out-of-hospital cardiac arrest and were treated by ambulance personnel. After excluding 65 patients who were randomized but later found to meet exclusion criteria (cardiac arrest induced by trauma, asthma, or anaphylactic shock; resuscitation not attempted; cardiac arrest witnessed by ambulance crew; or bystander physician-initiated resuscitation), 851 patients (mean age 64 y, 71% men) were included in the analysis.
Standard advanced cardiac life support (ACLS) without IV drug administration (n = 433) or ACLS with access to IV drug administration (control, n = 418). In the no-IV-drug group, IV access was to be established 5 minutes after return of spontaneous circulation (ROSC), and drugs given if indicated.
Survival to hospital discharge, hospital admission with ROSC, admission to the intensive care unit, survival to discharge with favorable neurologic outcome, and 1-year survival. The trial had approximately 90% power to detect an absolute difference of 7% in survival rate with α = 0.05.
93% of randomized patients and 100% of nonexcluded patients (intention-to-treat analysis).
IV drugs (mainly epinephrine) were given during resuscitation to 10% of the no-IV-drug group and 82% of the IV-drug group. Patients in the no-IV-drug group had poorer short-term outcomes, but groups did not differ for survival to discharge or 1 year (Table).
In patients with out-of-hospital cardiac arrest, withholding intravenous drugs did not improve the rate of survival to hospital discharge.
Standard advanced cardiac life support without vs with access to intravenous (IV) drugs in patients with out-of-hospital cardiac arrest†
†Abbreviations defined in Glossary. RBR, NNH, and CI calculated from data in article.
Stiell IG. Withholding intravenous drugs did not improve survival to hospital discharge in out-of-hospital cardiac arrest. Ann Intern Med. ;152:JC3–8. doi: 10.7326/0003-4819-152-6-201003160-02008
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Published: Ann Intern Med. 2010;152(6):JC3-8.
Cardiology, Emergency Medicine, Hospital Medicine, Rhythm Disorders and Devices.
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