Background and importance Early medication administration in cardiac arrest improves outcomes. Non-compliance with advanced cardiovascular life support (ACLS) guidelines, including errors in medication administration, have been shown to decrease return of spontaneous circulation (ROSC) and cardiac arrest survival.^{1 2}

Aim and objectives The primary objective was to evaluate the association between adrenaline administration in inhospital cardiac arrest (ICHA) patients with non-shockable rhythm and patient outcomes. The secondary objective was to assess compliance of adrenaline and amiodarone administration in accordance with ACLS guidelines.

Material and methods IHCA patients aged ≥18 years were identified from the resuscitation registry of 2016 of two large public hospitals and categorised according to their initial rhythms. For patients with non-shockable rhythms, the associations between IHCA outcomes, ROSC, survival to discharge and time of epinephrine administration were analysed by logistic regression.

Results Among 349 patients with non-shockable rhythm, median time to epinephrine administration was 3 min (IQR 1–6 min). Early epinephrine administration (<5 min), compared with late epinephrine administration (>5 min), was significantly associated with the rate of ROSC (49.2% vs 34.9%; adjusted OR 1.630; 95% CI 1.008–2.635, p=0.046). Time to epinephrine administration (as continuous interval) was significantly associated with the rate of ROSC (p=0.002) and survival to discharge (p=0.029). After adjusting for potential confounding factors, increased ROSC remained significant but the survival to discharge lost significance.

Conclusion and relevance Our study found that time of epinephrine administration was significantly associated with better results in ROSC and survival to discharge in IHCA patients with non-shockable rhythm. When we divided IHCA patients with non-shockable rhythms into early and late administration groups, early epinephrine administration was associated with significantly improved ROSC but not survival to discharge after adjusting for potential confounding factors. Compliance rate with ACLS guidelines was >80% regarding epinephrine and much less for amiodarone. Therefore, clinical pharmacy services should focus on methods to enhance amiodarone usage in cardiac arrest.

References and/or acknowledgements 1. McEvoy MD, et al. The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest. Resuscitation 2014;85:82–87.

2. Ornato JP, et al. Impact of resuscitation system errors on survival from in-hospital cardiac arrest. Resuscitation 2012;83:63–69.

No conflict of interest.