Context Intravenous access and drug administration are included in advanced cardiac life support (ACLS) guidelines despite a lack of evidence for improved outcomes. Epinephrine was an independent predictor of poor outcome in a large epidemiological study, possibly due to toxicity of the drug or cardiopulmonary resuscitation (CPR) interruptions secondary to establishing an intravenous line and drug administration. Objective To determine whether removing intravenous drug administration from an ACLS protocol would improve survival to hospital discharge after out-of-hospital cardiac arrest. Design, Setting, and Patients Prospective, randomized controlled trial of consecutive adult patients with out-of-hospital nontraumatic cardiac arrest treated within the emergency medical service system in Oslo, Norway, between May 1, 2003, and April 28, 2008. Interventions Advanced cardiac life support with intravenous drug administration or ACLS without access to intravenous drug administration. Main Outcome Measures The primary outcome was survival to hospital discharge. The secondary outcomes were 1-year survival, survival with favorable neurological outcome, hospital admission with return of spontaneous circulation, and quality of CPR (chest compression rate, pauses, and ventilation rate). Results Of 1183 patients for whom resuscitation was attempted, 851 were included; 418 patients were in the ACLS with intravenous drug administration group and 433 were in the ACLS with no access to intravenous drug administration group. The rate of survival to hospital discharge was 10.5% for the intravenous drug administration group and 9.2% for the no intravenous drug administration group (P = .61), 32% vs 21%, respectively, (P Conclusion Compared with patients who received ACLS without intravenous drug administration following out-of-hospital cardiac arrest, patients with intravenous access and drug administration had higher rates of short-term survival with no statistically significant improvement in survival to hospital discharge, quality of CPR, or long-term survival. Trial Registration clinicaltrials.gov Identifier: NCT00121524

https://jamanetwork.com/journals/jama/articlepdf/184947/joc90136_2222_2229.pdf

Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.

http://unmhospitalist.pbworks.com/w/file/fetch/90552086/1-s2.0-S0735109714064791-main.pdf

Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients

http://laerdalcdn.blob.core.windows.net/downloads/f2332/Resuscitation_Jan-2009.pdf

New visual feedback device improves performance of chest compressions by professionals in simulated cardiac arrest.

BackgroundContemporary learning technologies, such as massively multiplayer virtual worlds (MMVW), create new means for teaching and training However, knowledge about the effectiveness of such tra 

Allan Bromley

Papers

Chest compressions by ambulance personnel on chests with variable stiffness: abilities and attitudes.