VxPoD (241) : CARDIAC ARREST - ADRENALINE OR A PLACEBO?

The UK's Telegraph is reporting on a new study that will examine the effectiveness of adrenaline in the treatment of cardiac arrests.

What makes this study newsworthy is that the study will be a randomised controlled trial (RCT). This means that some participants will be given adrenaline and others will be given a placebo.

"Paramedics will give patients whose heart has stopped a dummy drug as part of an 'ethically questionable' study into whether adrenalin works in resuscitation or not, it has emerged."

"Patients in cardiac arrest will receive either a shot of adrenalin, which is the current practice, or a salt water placebo but the patient, their relatives nor the paramedic administering it will know which."

"The trial is seen to be controversial because patients will not be able to consent to taking part and could receive a totally useless placebo injection."

"Current guidelines used by UK ambulance services recommend routinely giving adrenalin during the resuscitation of patients who have suffered cardiac arrest. However, there are concerns that adrenalin may cause severe brain damage and may not help overall survival at all."

"The new study, led by Warwick University, has been approved by an ethics committee and will begin in the autumn in Wales, London, the South coast, North East and West Midlands. The first 8,000 patients who suffer a cardiac arrest will be included."

"Dr Martin Underwood, whose team at Warwick University are running the study, said there will be local advertising campaigns before the study begins and people will be able to opt out in advance. However he acknowledged that few were likely to do so and that the logistics of checking the identity and wishes of patients during frantic attempts to save their lives would be difficult."

"He stressed that all other resuscitation including heart massage and defibrillation would be conducted on all patients as normal. "We do not know that adrenalin does improve survival," he said. "It is possible that it improves short-term survival but few patients leave hospital and it may be at the cost of neurological damage. "It may in fact be something that is custom and practice that is actually harming people. "There are sufficient grounds for concern that what we are doing at the moment is detrimental to people."

"Professor Gavin Perkins, who is one of those leading the trial, said: “The need to do this research is underpinned by a serious concern that although using adrenalin might help restart the heart in the short term, it causes severe brain damage leading to death a few hours or days later."

“We want the best possible outcomes for all people who have a cardiac arrest, both now and in the future."

Would you agree to being part of this trial? Does the end justify the means? Is there a justification that discovering the true impact of adrenaline overrides the normal value we give consent? Would this sort of study impact on the way you view the paramedic profession, especially in light of their continual position at or near the top of 'trusted professions' (see here and here)?

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