Wednesday, August 13, 2014


Resuscitation drug adrenaline research in cardiac arrest study

A story on the BBC website brings up a lot of good discussion points.

1. Is epinephrine the right thing to give during a cardiac arrest?

This comes up quite a bit in discussions I have with other MDs. It is unknown. There is some evidence that sooner is better, some that less is better than more. We went away from the high doses we gave in the 90's, so it is realistic that we could move away from it altogether. I am not sure what will be the deciding point.Likely it will be a rogue system that decides to do without it and then shows their survival rates.

2. How can you figure these things out with patients who can not consent to participate in research?

To really know what works in cardiac arrest you need many patients. then you need them to consent to be part of the study.

So I ask the reader Knowing what you know, if you arrested, would you want epinephrine or not?

In the environment of patient safety, you need permission from a patient or family to put them in a study. The scene of a cardiac arrest is not optimal for any consent process.
So it falls to the IRB and community to decide if they are going to support doing the research without traditional consent. IRBs are going to approach it very differently and you may have extensive requirements to do it, like have community forums for people to ask questions.

3. Who would pay for it?

All of this comes at a cost, and then think about how many patients you would need to enroll. There is precious little funding for something like all of this. epinephrine is not a new drug that has a strong upside of success driving investors.

I think it is going to come down to someone deciding to go against the AHA guidelines, and current community (herd) practice and stop using it. If they doing everything else in the arrest the same, any change in survival would be a crude representation of the effects of epinephrine.
It would be a leap for any service.