Spontaneous circulation was restored three times more commonly with adrenaline (23.5%) than with saline placebo (8.4%) after cardiac arrest treatment. These were the results from the PACA (Placebo versus adrenaline versus cardiac arrest) study by Jacobs et al, soon to be published in Resuscitation, the official journal of the European Resuscitation Council.
In this single-centre double blind study, 601 out-of-hospital cardiac arrest victims were randomised to receive either placebo (0.9% sodium chloride) or adrenaline during advanced life support. Data available from 534 patients (262 placebo vs. 272 adrenaline) showed no difference in the primary end study point, survival to hospital discharge, but did show that a spontaneous circulation was restored three times more commonly with adrenaline (23.5%) than with saline placebo (8.4%).
Jacobs commented, “Our study highlights the significant challenges in undertaking randomised trials in cardiac arrest, particularly when it involves accepted but unproven therapy. Although we were unable to demonstrate that adrenaline improved the chance of surviving to hospital discharge, adrenaline did increase the likelihood of restoring circulation following cardiac arrest.”
Jerry Nolan, editor-in-chief of Resuscitation, said, “The authors are to be congratulated for undertaking this important study despite the very challenging factors that are inevitable in the out-of-hospital environment. This is the first placebo controlled trial in human cardiac arrest that has shown short term survival benefit for adrenaline.”