Guidelines for advanced cardiac life support (ACLS) specify IV drug administration, typically epinephrine, in addition to cardiopulmonary resuscitation (CPR). Because limited evidence shows a benefit from ACLS with IV drug administration, Olasveengen and colleagues compared the outcomes of patients receiving ACLS including IV drugs (control group) with those receiving ACLS without IV drugs (experimental group).

A total of 851 patients resuscitated after cardiac arrest were randomized into either the control (n = 418) or the experimental (n = 433) group by ambulance personnel at a single center in Norway. Short-term survival was significantly better in the IV (control) group than in the no IV (experimental) group (40% versus 25% of patients achieved return of spontaneous circulation, respectively), however a similar percentage of patients in each group survived to hospital discharge (10.5% versus 9.2%, respectively). There was also a similar percentage of those who survived with a favorable neurological outcome between groups (9.8% in the IVgroup compared with 8.1% in the no IV group).

Subgroup analysis revealed that patients in the IV group with nonshockable rhythms (asystole or pulseless electrical activity) had a higher rate of return of spontaneous circulation but a lower rate of survival to discharge, which the authors attributed to a delayed toxic reaction to the IVmedication. The authors questioned whether having shockable or nonshockable rhythms should be a factor in treatment. Additional analysis also showed that the quality of CPR delivered by ambulance staff was similar in both groups, indicating that administration of IV medication didn't negatively impact CPR quality.

While the authors acknowledge that the study has limitations (for example, it was a single-center trial), they also state that the efficacy of IV drug administration as a part of ACLS should be investigated further. They also suggest additional research into novel pharmacological interventions.