• Andres Neset, Trond Nordseth, Jo Kramer-Johansen, Lars Wik, and Theresa M Olasveengen.
• Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.
• Acta Anaesthesiol Scand. 2013 Nov 1;57(10):1260-7.

BackgroundWe wanted to study the effects of intravenous (i.v.) adrenaline (epinephrine) on rhythm transitions during cardiac arrest with initial or secondary ventricular fibrillation/tachycardia (VF/VT).MethodsPost hoc analysis of patients included in a randomised controlled trial of i.v. drugs in adult, non-traumatic out-of-hospital cardiac arrest patients who were defibrillated and had a readable electrocardiography recording. Patients who received adrenaline were compared with patients who did not. Cardiac rhythms were annotated manually using the defibrillator data.ResultsEight hundred and forty-nine patients were included in the randomised trial of which 223 were included in this analysis; 119 in the adrenaline group and 104 in the no-adrenaline group. The proportion of patients with one or more VF/VT episodes after temporary return of spontaneous circulation (ROSC) was higher in the adrenaline than in the no-adrenaline group, 24% vs. 12%, P = 0.03. Most relapses from ROSC to VF/VT in the no-adrenaline group occurred during the first 20 min of resuscitation, whereas patients in the adrenaline group experienced such relapses even after 20 min. Fibrillations from asystole or pulseless electrical activity, shock resistant VF/VT and the number of rhythm transitions per patient was higher in the adrenalin group compared with the no-adrenalin group: 90% vs. 69%, P < 0.001; 46% vs. 33%, P = 0.006; median 8 (5,13) vs. 2 (1,5), P < 0.001, respectively.ConclusionPatients who received adrenaline had more rhythm transitions from ROSC and non-shockable rhythms to VF/VT.© 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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