Adrenaline first or Airway in cardiac arrest.

Cardiac arrest has a poor survival rate. In this study Okubo et al(1) tried to address the question of adrenaline or airway first, in out of hospital cardiac arrest?

We appear to be forever looking to change the variables we have ie., adjust airway, or adrenaline dose, or something else, because we don’t have much else. ECMO for all may be the best approach, but not a realistic one.

The push for cardio-cerebral resuscitation with its emphasis on circulation before airway, may give better results in adult cardiac arrest, as the majority of adult arrests are cardiac and not respiratory in origin (compared to paediatric arrests) meaning that these patients are not hypoxic at the time of arrest.

The use, dose and timing of adrenaline is an area that is being questioned. Although we know that that is of greater benefit in non-shockable rhythms, we are almost certain that giving adrenaline to patients with a shockable rhythm, results in a worst outcome.