Study: IV Drugs May Not Improve Long-term Survival

(Ivanhoe Newswire) -- Patients with an out-of-hospital cardiac arrest who received intravenous (IV) drug administration had higher rates of short-term survival but no statistically significant improvement in survival to hospital discharge or long-term survival.

"Intravenous access and drug administration are integral parts of cardiopulmonary resuscitation (CPR) guidelines. Millions of patients have received epinephrine during advanced cardiac life support (ACLS) with little or no evidence of improved survival to hospital discharge," the authors were quoted as saying. "Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or CPR interruptions secondary to establishing an intravenous line and drug administration."
 
Theresa M. Olasveengen, M.D., of Oslo University Hospital, Norway, and colleagues compared outcomes for patients receiving standard ACLS with and without intravenous drug administration during out-of-hospital cardiac arrest in Oslo between May 2003 and April 2008. Of 1,183 patients for whom resuscitation was attempted, 851 were included in the study. A total of 418 patients received ACLS with intravenous drug administration, and 433 received ACLS with no intravenous drug administration.

Both groups had adequate and similar CPR quality, with few chest compression pauses and with compression and ventilation rates within the guideline recommendations.

"In the intravenous group, 44 of 418 patients survived to hospital discharge vs. 40 of 433 in the no intravenous group. Survival with favorable neurological outcome was 9.8 percent for the intravenous group and 8.1 percent for the no intravenous group," the authors wrote. "The cumulative postcardiac arrest survival rate at 7 days was 14.6 percent for patients in the intravenous group vs. 12.8 percent for patients in the no intravenous group, 11.3 percent vs. 8.8 percent, respectively, at 1 month, and 9.8 percent vs. 8.4 percent at 1 year."

The researchers note that after adjustment for ventricular fibrillation, response interval, witnessed arrest, or arrest in a public location, there was no significant difference in survival to hospital discharge for the intravenous group vs. the no intravenous group.

SOURCE: Journal of the American Medical Association (JAMA), November 25, 2009

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