Does IM Adrenaline improve survival in OHCA?

Adrenaline is recommended for all cardiac arrests with non-shockable rhythms and is associated with increased survival, especially if given in the first 10 minutes post arrest (1).

The rate limiting step, which can lead to significant time delays in adrenaline administration, is the establishment of intravenous(IV), or intraosseous(IO) access. Is intramuscular (IM) adrenaline a potential alternative? We already use it for anaphylaxis and in animal models, there is an indication that survival rates may be similar to IV adrenaline (2).

The aim of this study(3) “was to determine whether early IM adrenaline in adult, non-traumatic EMS-treated cardiac arrest is associated with improved survival to hospital discharge.”